Community-based Rehabilitation Program Research Articles

Barriers and facilitators for increased accessibility to quality rehabilitation services in low- and middle- income countries: a systematic review.

With an increasing number of people experiencing limitations in functioning during their life course, the need for comprehensive rehabilitation services is high. In 2017, the WHO Rehabilitation 2030 initiative noted that the need for the establishment and expansion of rehabilitation services is paramount in order to obtain well-being for the population and to ensure equal access to quality healthcare for all. The organization of rehabilitation services is however facing challenges especially in low-and middle-income countries with a very small proportion of people who require rehabilitation actually getting them. Various surveys conducted in low-and -middle income countries have revealed existing gaps between the need for rehabilitation services and the actual receipt of these services. This systematic review aimed to determine the barriers and facilitators for increasing accessibility to rehabilitation services in low- and middle-income countries. Recommendations for strengthening rehabilitation service organization are presented based on the available retrieved data. In this systematic review, an electronic search through three primary databases, including Medline (PubMed), Scopus and Web of Science (WOS) was conducted to identify original studies reporting on barriers and facilitators for rehabilitation service organization in low-and middle-income countries. Date of search: 25th April 2021 (PubMed), 3rd May 2021 (Scopus and Web of Science). All studies including barriers or/and facilitators for rehabilitation services in low- and middle income countries which were written in English were included in the review. The articles written in other languages and grey literature, were excluded from this review. Total of 42 articles were included from year 1989 to 2021. Numerous barriers were identified that related to education, resources, leadership, policy, technology and advanced treatment, community-based rehabilitation (CBR), social support, cultural influences, political issues, registries and standards of care. National health insurance including rehabilitation and funding from government and NGOs are some of the facilitators to strengthen rehabilitation service organization. Availability of CBR programs, academic rehabilitation training programs for allied health professionals, collaboration between Ministry of Heath (MOH) and Non-governmental Organizations (NGOs) on telerehabilitation services are amongst other facilitators. Recommendations for improving and expanding rehabilitation service organization include funding, training, education, and sharing of resources.

Effectiveness of Community-Based Rehabilitation (CBR) Centers for Improving Physical Fitness for Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis.

To synthesise the best available evidence for the effectiveness of interventions delivered in community-based rehabilitation (CBR) centers on physical fitness, for community-dwelling older adults living in Asian countries. This study is a systematic review and meta-analysis. Seven English and two Chinese electronic databases were searched for randomised controlled trials (RCTs) and quasi-experimental studies that were conducted by centers providing CBR. Independent reviewers screened, quality-appraised and extracted data. The primary outcome was physical fitness measured by validated assessment tools, including the Timed Up and Go Test (TUG), gait speed, hand grip strength, Functional Reach Test (FRT), and one-leg standing test. Assessments of activity of daily living and quality of life using tools including the Barthel Index, Short Form (SF)-12, and SF-36 were secondary outcomes. After screening 5,272 studies, 29 studies were included (16 RCTs, 13 quasi-experimental studies) from four countries. Meta-analyses found that CBR programs significantly decreased TUG time (mean difference [MD], -1.89 seconds; 95% confidence interval [95% CI], -2.84 to -0.94; I2=0%; Z=3.90, p<0.0001), improved gait speed (MD, 0.10 m/s; 95% CI, 0.01-0.18; I2=0%; Z=2.26, p=0.02), and increased one-leg standing time (MD, 2.81 seconds; 95% CI, 0.41-5.22; I2=0%; Z=2.29, p=0.02). Handgrip strength and FRT showed no statistically significant improvement in the meta-analyses. CBR may improve aspects of physical fitness for older adults in Asian countries. However, variability in intervention components and measurement tools reduced the ability to pool individual studies. Further trials are required with robust designs including standardised measures of physical fitness.

Caregivers' perspectives of community acceptance before and after surgical treatment for their child's disability.

In Tanzania, about 600 000 youth between 5 and 24 years old have a disability. Individuals with disabilities face numerous obstacles due to social stigma. The aim of this formative evaluation is to assess how caregivers of children with correctable disabilities (e.g., cleft lip/palate, club foot, and burn scar contractures) in Tanzania perceive their community's acceptance of their child before and after surgical treatment. Semi-structured interviews were conducted with 80 caregivers of children with disabilities treated at Kafika House in Arusha, Tanzania. The constant comparative method identified themes regarding the caregivers' feelings on their child's functional abilities and experiences of stigma in their community. Caregiver perceptions of stigma before and after surgical treatment were categorized and quantified as 'positive', 'neutral' and 'negative'. Thematic analysis of the 80 interviews resulted in five major themes: (1) stigma and acceptance (pre-treatment) and (2) post-treatment; (3) functional abilities (pre-treatment) and (4) post-treatment; and (5) emotional impact (pre- and post-treatment). These themes indicate caregivers and their children experience a range of emotional impacts before and after treatment, more severe stigma before treatment, and overall better social, emotional and functional status after treatment. Frequency analysis of caregiver experiences indicated that stigma experienced by children and their families decreased from 75% before surgical treatment to 2.5% after surgery. Surgical intervention and rehabilitation of physical disabilities mitigated experiences of social stigma for both children and their caregivers. Findings support the need for expanded treatment of correctable disabilities, larger investments in community-based rehabilitation programmes and further interventions to support stigmatized parents and their children.

Community-based rehabilitation/community based inclusive development functioning during the COVID-19 pandemic: A secondary analysis of qualitative data.

The coronavirus (COVID-19) became a global pandemic in March 2020 and impacted nations worldwide not only because of the disease but also because the containment measures-imposed created ripple effects for the populations in each country. The COVID-19 pandemic disproportionately affected vulnerable groups, such as persons with disabilities. This study aimed to understand the impact of COVID-19 on the function of Community-Based Rehabilitation (CBR)/Community-Based Inclusive Development (CBID) across nations and for their target communities-persons with disabilities. The current article also described some measures CBR/CBID programs took in light of service closure to facilitate access to needed services for persons with disabilities. We conducted a secondary analysis of qualitative data to understand the impact of COVID-19 on the functioning of CBR/CBID programs and their target communities. The original qualitative data were collected through online dialogues among CBR/CBID partners across five regions of the world, facilitated for understanding of their practices on five other topics. COVID-19 significantly impacted the function of CBR/CBID programs across the world. Many services were halted due to public health measures, such as maintaining social distancing or lockdowns. The COVID-19 pandemic also had a negative impact on access to health, education and livelihood support for persons with disabilities. Additionally, many people with disabilities did not have access to COVID-19 related information and services like vaccines. However, we found that technology played a significant role in revitalizing CBR/CBID programs during COVID-19. CBR/CBID service providers across five regions used online platforms to disseminate information about COVID-19. Professionals also used technology to provide rehabilitation and educational services to people with disabilities through online platforms. Our findings suggest that technology can play a vital role in continuing many services (e.g., CBR/CBID) that cannot be offered in person during crises like COVID-19. However, it is important to remember that technology may not be accessible to many individuals with disabilities, specifically those who reside in rural areas and who experience adverse situations like financial constraints. Additionally, many persons with disabilities may not have the necessary knowledge and skills to use technology. CBR personnel must consider that before adopting technology to provide services under CBR programs.

Community mobility and participation assessment of manual wheelchair users: a review of current techniques and challenges.

According to the World Health Organization, hundreds of individuals commence wheelchair use daily, often due to an injury such as spinal cord injury or through a condition such as a stroke. However, manual wheelchair users typically experience reductions in individual community mobility and participation. In this review, articles from 2017 to 2023 were reviewed to identify means of measuring community mobility and participation of manual wheelchair users, factors that can impact these aspects, and current rehabilitation techniques for improving them. The selected articles document current best practices utilizing self-surveys, in-clinic assessments, and remote tracking through GPS and accelerometer data, which rehabilitation specialists can apply to track their patients' community mobility and participation accurately. Furthermore, rehabilitation methods such as wheelchair training programs, brain-computer interface triggered functional electric stimulation therapy, and community-based rehabilitation programs show potential to improve the community mobility and participation of manual wheelchair users. Recommendations were made to highlight potential avenues for future research.

Affordability of an NGO-government partnership for community-based disability rehabilitation.

Tunafasi is a community-based rehabilitation (CBR) programme for persons with disability, implemented by a local non-governmental organisation in Uvira, Democratic Republic of Congo, in partnership with government. To assess affordability and support discussions with the government about continued financing and implementation, Tunafasi representatives commissioned a cost-effectiveness study of the programme's health component. This study aimed to estimate the programme's impacts, costs, cost per disability-adjusted life year (DALY) averted and affordability of the health component implemented from February 2019 to December 2021. Health-related improvements were assessed for a sample of 511 persons with disability and converted to DALYs averted. Total expenditure during the period February 2019 to December 2021 was estimated from audited financial statements. The cost per DALY averted was estimated by dividing total programme expenditure by the sum of DALYs averted and compared against newly generated, country-specific thresholds to assess affordability. The programme cost $55 729.00 to implement from February 2019 to December 2021 and averted 234 DALYs in 511 persons, at a cost per DALY averted of $224.00. This falls above the affordability threshold of $54.00 - $199.00. While the cost per DALY averted is higher than what thresholds consider affordable for Democratic Republic of Congo, improved engagement from CBR facilitators and greater possibilities for treatment in the post-pandemic era should improve results. This new CBR implementation modality offers a possibly affordable solution to African governments struggling to operationalise disability commitments such as United Nations Convention on the Rights of Persons with Disabilities.

Community-based group rehabilitation program for stroke patients with dysphagia on quality of life, depression symptoms, and swallowing function: a randomized controlled trial

BackgroundCommunity-based exercise programs have demonstrated potential for implementation in older adults; however, it remains imperative to ascertain whether this strategy will yield comparable benefit in stroke patients with dysphagia.MethodsThis was a single blinded, randomized, matched pairs clinical trial. Sixty-four stroke patients with dysphagia were recruited from patients who had been discharged the Rehabilitation Department of the Third Affiliated Hospital of Sun Yat-sen University. A single blinded, randomized and controlled trial was conducted. Participants were randomly assigned to either the intervention group (n = 32) or the control group (n = 32). Patients in the intervention group received health education followed by swallowing function training in community public spaces for 5 days every week over an eight-week period (60 minutes per day). Patients in the control group received swallowing rehabilitation training, and booster educational information about dysphagia, as well as instructions on how to improve quality of life. Swallowing function (Functional Oral Intake Scale (FOIS) and Standardized Swallowing Assessment (SSA)), depressive symptoms (Geriatric Depression Scale-15), and quality of life (Swallowing-Quality of Life, SWAL-QOL) were assessed before and after all the treatment.ResultsBefore treatment, the two groups did not differ statistically. After the intervention, the swallowing function (SSA and FOIS) showed a significant improvement in both groups (All p < 0.001). But there was no significant difference in Functional Oral Intake Scale change between groups (P = 0.479). Compared with the control group, the intervention group had a significant improvement in depressive symptoms (P = 0.002), with a greater reduction in the number of depressed patients (13 to 6).The control group showed no significant improvements in depressive symptoms or a reduction in the number of depressed patients before and after treatment (P = 0.265, 14 to 12). The Swallowing-Quality of Life scores showed significant improvement in both the intervention and control group (P < 0.001). Specifically within Swallowing-Quality of Life sub-domains, greater changes were observed in symptoms and frequency (P < 0.001), communication (P = 0.012), and sleep (P = 0.006) for participants in the intervention group. And the cost-effectiveness of group rehabilitation surpasses that of rehabilitation training.ConclusionCommunity-based group rehabilitation program is more effective than traditional treatment in improving patients’ depressive symptoms and quality of life, as well as being more cost-effective.

Inclusion of Persons with Disabilities in Nigeria: A Pre-Requisite for National Sustainable Development

Globally, several efforts have been made to promote the rights and inclusion of vulnerable members of society, however, persons with disabilities (PWDs) in Nigeria are constantly faced with several barriers to their full participation in social, economic, political, and environmental circles. These challenges which have been discovered to be a result of societal prejudice/misconceptions, limited resources, inability to access necessary facilities/resources, educational discrimination/limitations, employment discrimination, and policy gaps can present significant obstacles to their abilities to acquire and execute skills that will make them self-sustainable and contribute meaningfully to society, ultimately hindering collective national sustainable development. This study adopts a comprehensive study of relevant literature, observation, and interview at centres for PWDs to address the societal attitudes, discriminatory practices, and specific obstacles faced by PWDs in Nigeria. A comparison of inclusive practices in other developing and developed nations were made to show the progress Nigeria has made and the gaps that need to be filled. The study further explores the negative impacts of exclusion on national sustainability, and the implications of disability inclusion on the promotion of economic, social, political, and environmental sustainability in Nigeria. Conclusively, this research proposes some recommendations to address the barriers limiting disability inclusion in Nigeria, through the employment of specific strategies such as creating awareness of disability issues, providing accommodations, promoting inclusive policies, and engaging in community-based rehabilitation programs which when implemented will improve the quality of life of PWDs, thus promoting their contribution to national sustainable development.

Emotion Introduction Program "Senia" (Non-Verbal Expression and Interaction Art for Activities) for ODGJ Patients tt Rskd Dadi in the City of Makassar

People with mental disorders, especially schizophrenia, struggle to recognize and manage their emotions. Therefore, community-based rehabilitation programs like SENIA are necessary to help them develop an understanding of emotions, emotional expression, and empathy. This program involves activities such as emotion recognition, emotion identification through card games, practicing emotion recognition with pictures, and education on healthy emotional expression. The results of the first stage show patient participation, the second stage indicates improvement in their ability to identify and narrate emotions, and the third stage involves patients in expressing emotions healthily under expert guidance. Although the program is running well, there is a need to consider the development of programs that involve more individuals comprehensively and maximally.

327 A review of patients referred to community rehabilitation (ExWell Medical) from gerontology clinic in a regional hospital

Abstract Background ExWell Medical is an established community-based chronic illness rehabilitation programme which was founded in 2006. It is a not-for-profit company with over 2000 in-person patient visits per week, across 22 centres in Ireland. Its referrals stem from hospital consultants, general practitioners and other allied health professionals. The rationale behind ExWell Medical is that a large proportion of the disability that comes with any long-term illness is caused by deconditioning. It is particularly aimed at the ageing population who may find it difficult to engage with local services and have poor motivation. ExWell Medical offers community-based supervised exercise classes, as well as home programmes. Methods We performed an audit looking at the number and demographics of patients referred to ExWell Medical from 12/01/2022–22/5/2023 from the Gerontology Frailty Hub in a regional hospital. All patients attending the clinic during this time were included, and data was logged at each appointment. I then performed a retrospective analysis of patients referred to community rehabilitation. Results The total number of patients was 656 (322 male (49%), 334 female (51%). Of these, 67 were referred to ExWell Medical, 587 did not warrant referral and 2 were excluded due to lack of data. This correlates with a 10.2% referral rate. We proceeded to assess the demographics of those referred, which showed 67% were female and 33% were male. With regards to age; 4 patients were &amp;lt; 70 (6%), 15 were 70–75 (22.3%), 23 were 76–80 (34.3%), 14 were 81–85 (21%), 10 were 86–90 (15%) and 1 patient was over 95 (1.5%). Conclusion The referral rate to ExWell Medical was less than expected, and especially low in men. By highlighting this we hope to increase the number of patients referred in the future, as well as reducing the gender disparity.

Co-design of a Community-based Rehabilitation Program to Decrease Musculoskeletal Disabilities in a Mayan-Yucateco Municipality

Abstract: Background: Chronic musculoskeletal (MSK) diseases are an important cause of disability in the Mayan community of Chankom in Yucatán, Mexico. Objective: To understand a community-based participatory research (CBPR) strategy implemented in Chankom to design a community-based rehabilitation (CBR) program for people living with MSK diseases. Methods: Qualitative descriptive thematic analysis from an ethnographic work conducted in Chankom, during the implementation of a CBPR strategy from 2014 to 2017. Results: Four main themes describe the main processes that formed our CBPR strategy: 1) forming and maintaining an alliance between academic and community members, 2) prioritizing community needs, 3) integrating local and global knowledge and 4) shared-decision-making. This CBPR strategy allowed the design of a CBR program formed by six main interventions: 1) health services coordination, 2) personal support, 3) community venous blood sampling services, 4) community specialized services, 5) health promotion, and 6) health transportation services. Conclusions: Co-designing a CBR program for people living with chronic MSK diseases in Chankom was possible through an extensive community engagement work structured around four main processes, including the essential principles of CBPR. The designed CBR program includes culturally sensitive interventions aimed at improving the quality, availability, accessibility, and acceptability of health care services. Moreover, the program mainly addressed the "health" component of the World Health Organization–CBR matrix, suggesting a need for a new CBPR cycle after it is implemented and evaluated in the future.

Nutritional status as predictors for quality of life among caregivers of children with severe cerebral palsy.

Individuals with severe cerebral palsy (CP) often experience various health issues, including feeding difficulties, which can adversely affect their nutritional status and caregivers' quality of life, e.g., more time spent for feeding rather than own selfcare. This study aimed to determine the prevalence of poor nutritional status among individuals with severe CP and explore its role as predictors for caregivers' quality of life. This cross-sectional study was conducted in a government hospital (Cheras Rehabilitation Hospital), Community-Based Rehabilitation (CBR) Program, and Spastic Centre [non-profit organization (NGO)] in Klang Valley, Malaysia. Seventy-one participants with Gross Motor Function Classification System (GMFCS) level IV and V were recruited. Sociodemographic data, health-associated data, and anthropometric data were collected. Caregivers' quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL) CP module version 3.0 which included domains such as Movement and Balance, Eating Activities, and School Activities. Most participants were males (60.6%), with 61 classified as level IV in the GMFCS classification. According to the Eating and Drinking Ability Classification System (EDACS), 59 children were at level IV. In total, 40.8% were underweight according to CP growth chart and 49.3% had mid-upper arm circumference (MUAC) readings below the 5th percentile. The lowest scores in the PedsQL CP module version 3.0 were observed in the Daily Activities (5.34±10.87), and School Activities domains (8.15±18.65). Sociodemographic and anthropometric data, including body mass index (BMI)-for-age, MUAC, body fat, triceps, and subscapular skinfold measurement, were predictors for the School Activities domain [F (11, 44)=3.981, P<0.005, R2=0.499]. Poor nutritional status in individuals with severe CP has been shown to negatively impact caregivers' quality of life. Therefore, a multidisciplinary approach involving nutritional intervention is essential to improve dietary provision and the nutritional status of children with CP.

Co-design of a Community-based Rehabilitation Program to Decrease Musculoskeletal Disabilities in a Mayan-Yucateco Municipality

Co-design of a Community-based Rehabilitation Program to Decrease Musculoskeletal Disabilities in a Mayan-Yucateco Municipality

The Effectiveness of Nursing Rehabilitation Interventions on Self-Care for Older Adults with Respiratory Disorders: A Systematic Review with Meta-Analysis.

Background: This research work aimed to summarize the rehabilitation nursing interventions published in the scientific literature that most contribute to effective adherence to self-care in older adults with respiratory diseases. Methods: A systematic literature review with meta-analysis was conducted by searching the EBSCOhost platform (CINAHL Complete, MEDLINE Complete, Cochrane, and MedicLatina) using the PRISMA methodology. Five articles were selected for final analysis. Meta-analysis was carried out using Comprehensive Meta-Analysis (CMA) software, and the results were presented in a forest plot. Results: Thirty-one self-promoting rehabilitation nursing interventions were identified, with the most effective being those related to the assessment of progress in physical capacity/activity tolerance (functional status category/domain) and the assessment of the increase in health-related quality of life (health-related quality of life category/domain). Conclusions: Rehabilitation nursing interventions such as self-management programs led by nurses, community-based and home-based rehabilitation programs, and inspiratory muscle training can effectively reduce and enable the effective control of symptoms associated with respiratory disorders, boosting older adults' empowerment to engage in self-care.

Supporting stroke survivors to meet their personal rehabilitation needs in community-based arm rehabilitation: development of initial programme theories to explore what may work for whom, how and under what circumstances.

This study explored what worked for whom, how and under what circumstances in a community-based augmented arm rehabilitation programme that was designed to enable stroke survivors to meet their personal rehabilitation needs. A mixed methods realist-informed study of data from a randomised controlled feasibility trial, comparing augmented arm rehabilitation after stroke with usual care. The analysis was designed to develop initial programme theories and refine these through triangulation of qualitative and quantitative trial data. Participants with a confirmed stroke diagnosis and stroke-related arm impairment were recruited from five health boards in Scotland. Only data from participants in the augmented group were analysed. The augmented intervention comprised evidence-based arm rehabilitation (27 additional hours over 6 weeks) including self-managed practice, and focused on individual rehabilitation needs identified through the Canadian Occupational Performance Measure (COPM). The COPM indicated to which extent rehabilitation needs were met following the intervention, the Action Research Arm Test provided data on changes in arm function, and qualitative interviews provided information about the context and potential mechanisms of action. Seventeen stroke survivors (11 males, age range 40-84 years, NIHSS median (IQR) 6 (8)) were included. Median (IQR) COPM Performance and Satisfaction scores (min.1-max.10) improved from pre-intervention 2 (5) to post-intervention 5 (7). Findings suggested that meeting rehabilitation needs was facilitated by strengthening participants' sense of intrinsic motivation (through grounding exercises in everyday activities linked to valued life roles, and enabling them to overcome barriers to self-managed practice), and via therapeutic relationships (through trust and expertise, shared decision-making, encouragement and emotional support). Collectively, these mechanisms enabled stroke survivors to build confidence and gain mastery experience necessary to engage in new self-managed practice routines. This realist-informed study enabled the development of initial programme theories to explain how and in what circumstances the augmented arm rehabilitation intervention may have enabled participants to meet their personal rehabilitation needs. Encouraging participants' sense of intrinsic motivation and building therapeutic relationships appeared instrumental. These initial programme theories require further testing, refinement, and integration with the wider literature.

Biopsychosocial predictors of drug dependence among Filipino drug users in community-based drug rehabilitation

This study examines the biopsychosocial predictors of drug use and dependence among Filipino drug users enrolled in community-based drug rehabilitation. Data from 925 clients revealed that the severity of drug use, cigarette and alcohol use, recovery skills, and mental health problems predict drug dependence. Family support, life skills, and psychological well-being are indirect predictors of severity of use. Results also revealed differences in predictors by sex, level of use, and type of clients. These findings highlight the importance of a client-centered approach to treatment and suggest what might be critical elements in a community-based drug rehabilitation program in the Philippines.

Cardiovascular risk factor profile in patients admitted to a community-based cardiac rehabilitation program after one year: what risk factors are not being controlled?

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac rehabilitation (CR) is a multidisciplinary intervention designed to reduce cardiovascular (CV) risk, encourage healthy behaviors, reduce physical impairment, and promote an active lifestyle. After completing a phase II CR program, it is important to maintain long-term CV risk factor control. However, many patients do not achieve or maintain lifestyle and risk factor targets on a long-term basis. Therefore, it is of interest to understand which risk factors are not reaching the targets to better understand and personalize long-term community-based CR programs. Purpose To characterize the modifiable CV risk factors profile in coronary artery disease (CAD) patients admitted to a community-based phase III CR program, including lipid profile, overweight/obesity, physical activity (PA) and sedentary behaviour (SB), at the beginning and after completing the first year of the CR program. Methods This retrospective cohort study included CAD patients that attended for 1-year a community-based phase III CR program. At the beginning (M0) and after one year (M1) of the CR program, all patients performed a risk profile assessment including: Lipid profile [total cholesterol (total-c), high density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL)], body mass index (BMI), PA and SB. BMI was assessed with the patient's weight in kilograms divided by the square of height in meters and lipid profile values were obtained from blood testing. PA and SB were objectively measured by using an accelerometer. All participants attended supervised exercise sessions, 3x week, 60 mins, including aerobic and resistance exercises, 3 educational sessions and a nutritional counseling consultation per year. Results In the sample of 159 patients at baseline (81.8% male, mean age 61±10 years, BMI: 28.3±4.3 kg/m²), overweight and obesity proved to be the most prevalent risk factor (80.7%), followed by uncontrolled LDL levels (74.8%). After a 1-year intervention (n=48, 90% male, mean age 62±10 years), LDL levels were kept above the targets (M0: 73.3±28.9 mg/dL and M1: 68.6±19.6 mg/dL, p=0.186), BMI did not change (M0: 27.5±3.9 kg/m² and M1: 27.8±4.0 kg/m², p=0.168) and SB remained high (M0: 11.50±2.90 hours/day and M1: 11.58 ± 2.71 hours/day, p=0.908). Although, moderate to vigorous PA (MVPA) decreased (M0: 343±195 mins/week and M1: 293±164 mins/week, p&amp;lt;0.001), participants were still on target, between 150 to 300 mins MVPA week. Conclusion Our findings show that after a 1-year of a phase III CR program intervention CVD patients maintained MVPA recommended levels, but did not reach body composition, lipid profile, and SB targets. Future strategies should be implemented in long-term CR programs to better control LDL, body composition and SB.

The current situation of community-based rehabilitation in commune health station of a district in Nghe An province

Community-based rehabilitation (CBR) has been proven effective for people with disabilities (PWDs) and their families, saving medical resources, and is particularly suitable for developing countries1,2. However, in Vietnam, due to the lack of facilities and CBR human resources, the rehabilitation needs of PWDs were not met. Thanh Chuong is a district that has implemented CBR activities at commune health stations for PWDs, in conjunction with the project on victims of the toxic chemical Dioxin. Several duties have been assigned to commune health workers as stated in the CBR program, yet commune health workers were not assigned specifically to do rehabilitation tasks. This study aims to describe the current status of CBR activities at commune health stations, in Thanh Chuong district, Nghe An Province in 2022. The study used a cross-sectional design, mixed methods were employed. The study was conducted from December 2021 to August 2022. Qualitative data are analyzed thematically. Participants were mainly female, about half of them aged 30-49 years old, most of them are nursing, and general medical staff and no staff had a rehabilitation background. The level of performance and confidence in performing the tasks were similar. Among the 8 tasks assigned to the commune health stations, 3 tasks have been performed in 38 communes at different levels including making management records, classifying PWDs, and reporting on transferring PWDs to higher levels. However, these activities are not carried out properly and sufficiently and there was no list of people with disabilities. It is necessary to review the list of CBR activities and have policies to support these activities at the grassroots level, especially to have a health worker in charge of CBR available to fully implement the program's activities, thus helping PWDs integrate into the community, and reducing caring burden or caregivers for PWDs.

Designing a content validated community needs assessment questionnaire for Barangays in Binangonan, Rizal: a psychometric study

Introduction: Needs assessment is essential before developing a community-based rehabilitation program to identify the factors that may affect the quality of life (QOL) in a community. However, no assessment tools were readily accessible and directed toward this study's target population and research locale. The study aims to develop and validate Community Assessment for Rehabilitation Enhancement (CARE), a PRECEDE-PROCEED model-based questionnaire that assesses the needs of barangays in Binangonan, Rizal. Methods: The questionnaire items were grounded on related literature using keywords and Boolean operators across various research databases. A purposive sampling method was utilized to recruit a panel of experts to evaluate CARE’s content validity. Content validity was assessed by evaluating the tool’s grammar, choice of words, question construction, and scoring of items. The researchers then analyzed the data using content validity ratio (CVR) and content validity index (CVI). Results: After reviewing related literature, the researchers generated 75 items for CARE, 55 of which were deemed appropriate based on the CVI. However, only one item in the questionnaire had a CVR result of at least 0.99. Discussion: To further improve the current status of the questionnaire, additional rounds of Delphi, more panel experts, and a Filipino translation of the questionnaire may be done.

Disability, Rehabilitation, and Assistive Technologies for Refugees and Asylum Seekers in Italy: Policies and Challenges

Good health and well-being for all, including those with disabilities, is one of the main sustainable development goals. Data on refugees and asylum seekers with disabilities are limited. Refugees have poor access to rehabilitation and assistive technologies, although laws and policies in Italy guarantee this type of healthcare. However, there are several limitations to the successful implementation of these services. First, the national health system is regionally based, and therefore healthcare facilities and services vary in terms of quality in different regions. A link between reception centers and the healthcare system is therefore highly recommended, because only 10 out of 20 regions have specific services for refugees and asylum seekers with disabilities. Second, only 2% of the total available posts for hosting refugees are reserved for people with disabilities. The lack of a standardized vulnerability assessment represents the main barrier to the organization of specific services for migrants within the community. National stakeholders urgently need to collaborate in order to remove barriers to rehabilitation and assistive technology for refugees with disabilities. Initiatives should focus on health literacy and the empowerment of migrants, data collection on health, disability, and assistive technology, and the organization of community-based rehabilitation programs.