Community-based Rehabilitation Program Research Articles

Impact of an Asian Community-Based Cancer Rehabilitation Program on Health-Related Quality of Life

Background/Objectives: Inpatient exercise-based rehabilitation has been shown to improve health-related quality of life (HRQOL) in cancer survivors. However, there is a lack of studies on the impact of community-based cancer rehabilitation programs on health-related quality of life, especially in Asian countries. Methods: This was a retrospective cohort study involving patients with cancer at an outpatient community-based rehabilitation center. There were 197 patients who were recruited and enrolled in a physician-led rehabilitation program which included physiotherapists, occupational therapists, nutritionists and exercise physiologists. Results: Most of the patients had a diagnosis of breast cancer (61.4%), while 76 (38.6%) had a diagnosis of other cancers. On initial assessment, we found a mean Distress Thermometer (DT) level of 3.37 (SD = 2.41) and a mean Functional Assessment of Cancer Therapy-General-7 Item Version (FACT-G7) score of 11.83 (SD = 4.01). On follow-up assessment after 3–6 months of rehabilitation, there was a significant reduction in mean DT level to 2.42 (SD = 2.25) and an improvement in mean FACT-G7 score to 13.09 (SD = 4.77). Multivariate regression analysis revealed that significant factors for improvement in FACT-G7 scores were age (p = 0.046) and number of exercise therapy sessions (p < 0.001). Conclusions: This study demonstrates the positive impact of a community-based cancer rehabilitation program on HRQOL among cancer patients.

Exploring Education Interventions for Stroke Prevention Among Adults and Older Individuals: A Scoping Review.

This investigation aims to conduct a comprehensive review of educational interventions targeting stroke prevention to provide effective preventive measures and optimize resource utilization in adults and the elderly populations. A comprehensive literature search was conducted on PubMed, SCOPUS, and Embase for articles published online or in print until February 22, 2022. Inclusion criteria for studies were limited to the studies that examined stroke education or training interventions aimed at improving knowledge among adults aged 30 years and above, with a particular focus on older adults. A review of 97,848 papers was conducted, resulting in the inclusion of 19 papers. Of these, six were randomized controlled trials (RCTs), six were non-randomized studies, five were campaign studies, one was a cross-sectional study, one was a pilot study, and one was a prospective study. The provided information describes various interventions and educational programs related to stroke awareness, prevention, and management. The intervention subjects were categorized as awareness of warning signs and symptoms of stroke (n = 14), comprehensive awareness campaigns (n = 5), multilevel strategies for stroke education (n = 4), community-based nursing education and rehabilitation program (n = 5), multimedia campaign for 9-1-1 awareness (n = 3), and self-management interventions (n = 1). The categorized interventions, addressing awareness of warning signs and symptoms, comprehensive awareness campaigns, multilevel strategies, community-based nursing education and rehabilitation programs, multimedia campaigns for 9-1-1 awareness, and self-management interventions, collectively enrich our understanding of the multifaceted approaches to stroke education.

Feasibility of a 10-week community-based mobile health rehabilitation program using the WalkWithMe application in late sub-acute and chronic stroke survivors in a low resource setting: A pilot study

ABSTRACT Physical functioning can be increased in people with stroke by using a mobile health application. This study aimed to investigate the feasibility of a 10-week community-based program using the WalkWithMe (WWM) application in people with late sub-acute and chronic stroke in Benin. An interventional pilot study with mixed methods research design was used examining the application of an unsupervised individualized mobile Health (mHealth) instructed training program. Main outcome included the application usage, safety, adherence, perceived enjoyment, mHealth quality, patient experiences and pre-post efficacy measures. Nine adults, five males, median age of 60 years and time since stroke of 12 months participated in this study. For most participants adherence with the application was over 70%. However, some usability problems were observed due to incorrect understanding and use by participants and technical problems. The application was very fun, stimulating and enjoyable. Significant improvements were found with median (pre/post measures) of locomotors skill (1.4/3.4); impairments (38/40), Barthel Index (85/95), activity limitation (2.1/3.1), and quality of life (194/218). A trend towards significant improvement was found with 6 minutes walking test (181/220, p = 0.06). The WWM application is perceived as a potential approach to increase physical activity and functioning among people with stroke in Benin.

Physical Activity Behaviour and Motivation During and Following Pulmonary and Cardiac Rehabilitation: A Repeated Measures Study.

Exercise rehabilitation programmes are important for long-term health and wellbeing among people with cardiac and pulmonary diseases. Despite this, many people struggle to maintain their physical activity once rehabilitation ends. This repeated measures study tracked changes in physical activity behaviour and motivation during and after completing a community-based exercise rehabilitation programme. Cardiac and pulmonary exercise rehabilitation patients (N = 31) completed six once-monthly measures of physical activity (MET·min), self-determined motivation, intention, and habit strength for rehabilitation exercise (within rehabilitation sessions) and lifestyle physical activity (outside of rehabilitation sessions). Linear regression and random effects models with estimated marginal means were used to test for associations between physical activity motivation and behaviour and change during and post-rehabilitation. Overall physical activity decreased after rehabilitation (823 MET·min) despite patients becoming more self-determined for lifestyle physical activity during rehabilitation. More self-determined motivation, stronger intentions, and stronger habits were associated with more lifestyle physical activity behaviour. However, none of these motivation variables were significantly associated with rehabilitation exercise behaviour. Among community-based cardiac and pulmonary rehabilitation patients, physical activity levels decreased following exercise rehabilitation programmes. The findings revealed clear distinctions in the motivation of rehabilitation exercise compared to lifestyle physical activity. Exercise rehabilitation programmes might improve the longevity of outcomes by integrating approaches to enhance lifestyle physical activity beyond the clinic.

Crafting the Future of Community-Based Medical Rehabilitation: Exploring Optimal Models for Non-Inpatient Rehabilitation Services through a Narrative Review.

Community-based medical rehabilitation encompasses diverse programs that cater to patients outside of inpatient settings, such as home rehabilitation, day rehabilitation centers, and ambulatory clinics. While inpatient rehabilitation principles are widely standardized, outpatient programs display significant variability influenced by healthcare models, local environments, economic constraints, and available resources. This narrative review aims to explore and synthesize the various models of non-inpatient rehabilitation services, evaluating their effectiveness, cost-efficiency, and patient satisfaction. The review also seeks to identify optimal practices and strategies to enhance community-based rehabilitation, alleviate the burden on inpatient facilities, and improve patient outcomes through multidisciplinary and patient-centered approaches. Additionally, the study examines the critical role of a professional program coordinator and the importance of effective clinical communication in outpatient rehabilitation. A comprehensive search of peer-reviewed literature was conducted across multiple databases, focusing on studies that examined community-based rehabilitation models. The findings suggest that community-based rehabilitation programs are generally more cost-effective than inpatient programs, with their success being heavily dependent on the intensity and timing of interventions. Multidisciplinary approaches and high-intensity rehabilitation have shown promise in improving patient quality of life, though their effectiveness varies by condition. Despite limited research, the involvement of a Physical and Rehabilitation Medicine (PRM) physician as a program coordinator appears vital for ensuring continuity of care. Moreover, effective clinical communication is essential, impacting all aspects of patient care and interprofessional collaboration, with continuous adaptation required to meet the evolving needs of diverse patient populations.

Clinical Outcomes and Cost Implications of a Community Psychosocial Rehabilitation Service for Severe and Persistent Mental Illness in Nova Scotia, Canada.

Introduction: Individuals with severe and persistent mental illness (SPMI) present distinct challenges in mental healthcare due to the chronic and complex nature of their conditions. This study was conducted to assess the clinical efficacy and potential cost-effectiveness of a multidisciplinary community-based psychosocial rehabilitation team serving individuals with SPMI in Nova Scotia, Canada. Method: This study was conducted to evaluate the effects of a community-based psychosocial rehabilitation program on individuals with severe and persistent mental illness (SPMI) in Nova Scotia, Canada. This research focused on clinical outcomes and potential cost savings following a one-year intervention, offering critical insights into the benefits of community-based care for this population. A cohort of 137 clients accepted into the community rehabilitation service (Connections Dartmouth) between September 2016 and September 2020 was analyzed. Each participant received one year of community rehabilitation intervention. Using data from the Canadian Medical Service Insurance (MSI) billing system, this research compared the use of inpatient services and Emergency Department visits in the year prior to and the year following the intervention. The findings provide valuable evidence on the role of community rehabilitation in reducing healthcare utilization for individuals with SPMI. Results: The results demonstrated a statistically significant reduction in mean admission rates and length of inpatient admissions in the year following rehabilitation compared to the pre-rehabilitation year. A substantial percentage of patients experienced no inpatient admissions (88% vs. 60%) or Emergency Department visits (82% vs. 67%) in the post-rehabilitation year, compared to the pre-rehabilitation year. There was a significant reduction in inpatient days by 90%, translating into substantial cost savings. The findings highlight the potential economic benefits of community rehabilitation for people with SPMI. Conclusions: This uncontrolled study suggests that community rehabilitation is associated with positive clinical outcomes for individuals with SPMI in terms of reduced inpatient service use and associated costs. Further research, including controlled studies and cost-effectiveness studies, into the community psychosocial rehabilitation services in the Canadian setting is needed.

Employment Among Women with Severe Mental Illness Availing Rural Community-based Rehabilitation Program: A Qualitative Study from South India

Background: Women in India are often disadvantaged in accessing education, employment, health services, and decision-making within families. This inequality is particularly pronounced among women with severe mental illness, especially those from rural areas. Methods: The study explored the employment status, facilitators, and barriers to employment among women with severe mental illness availing a rural community-based rehabilitation (CBR) program in Jagaluru, South India. Interviews were conducted with 15 women, their family caregivers, the CBR program social worker, and a community program coordinator of a nongovernmental organization partner. The study used a qualitative research design. Thematic analysis was used to identify emerging themes. Results: Ten women were employed. Among five unemployed women, two independently took care of household responsibilities, and one assisted the family. Medication compliance and the desire to earn money for oneself were significant facilitators. Employment opportunities for some women were hindered by poor bus connectivity in interior villages, patriarchal familial attitudes, and challenges in availing loans for livelihood ventures. Conclusion: Rural families access treatment for severe mental illness when it is available at the nearest government health facility. With symptom improvement, many women could avail themselves of local employment opportunities without additional inputs from the CBR team.

Community-based Rehabilitation Support Programmes and Social Inclusion of Persons with Disabilities in Tigania East, Kenya

Community-based rehabilitation programmes (CBR) are considered fundamental in improving the well-being of persons with disabilities by facilitating access to basic services like healthcare, education, housing, and employment and fostering their participation in the community through the transfer of knowledge and skills concerning disability and rehabilitation to people with disabilities, their families and the community at large to enhance social inclusion. However, despite the existence of the Disability Community programmes, it is not clear how community-based rehabilitation support has fostered the social inclusion of persons with disabilities in Kenya. Based on the data from Tigania East, Meru County, Kenya, this paper explores the impact of community-based programmes on the social inclusion of persons with disabilities with a view to influencing policy formulation to foster livelihood and inclusion of the disability in the community agenda.

Co-Designing a Community-Based Cardiac Rehabilitation Program for Chinese Migrants in Australia: A Mixed Method Study

Co-Designing a Community-Based Cardiac Rehabilitation Program for Chinese Migrants in Australia: A Mixed Method Study

Utilization Community-Based Rehabilitation Methods to Improve Independence and Quality of Life for Patients with Disabilities in Nara Phirom Health Promoting Hospital, Thailand

The disability community activity, Nara Phirom Health Promoting Hospital in Banglen District, Nakhon Pathom, Thailand, collaborated with the Faculty of Physiotherapy, Mahidol University to support the disability community. Using the Community-based rehabilitation (CBR) method, the aim to enhance independence and quality of life. Evaluation includes IADL for independence and WHOQoL Bref-100 for quality of life. Education on health, immobilization, and exercise was provided to patients, families, and caregivers. Therapists teached physical exercises, to be repeated 2-3 times daily by caregivers and family. The 1-month program, supervised by therapists, includes standing and walking for patients with lower extremity strength of 3/5 (measured by manual muscle testing). Rehabilitation involves crafting items like wallets and bags, stamps, and flowers from bottles. Results, patients with low function status (very dependent on other people) decreased by 64.3%, moderate function increased by 116.7% and independence increased by 111.1%. There was a significant improvement in quality of life (WHOQoL) and all domains after CBR program.

Barriers and enablers to help seeking, treatment adherence and recovery among community-based drug rehabilitation clients in the Philippines

Background This study aimed to determine factors influencing help-seeking, accessing treatment and sustaining recovery among Filipino PWUDs during the country’s war against drugs. Methods Purposive sampling was used with respondents recommended by program managers or community facilitators of community-based drug rehabilitation programs. In-depth interviews with clients and their families were conducted in 17 local government units across 8 regions in the Philippines. Transcripts were analyzed using Nvivo 12. Results The results highlight barriers to help-seeking, including the PWUDs’ belief that they don’t need help, fear of police and incarceration, stigma and discrimination. Enablers to help seeking and treatment adherence were motivation to change, accessible treatment options and family support. Community acceptance, quality of care of service providers, and support of community leaders enabled both help-seeking and recovery. Conclusion The findings suggest the impact of a punitive approach and the need to reframe drug use as a health issue. Results also suggest the need to reduce stigma and discrimination and promote positive messaging to enable help-seeking, adherence, and recovery.

Community Based Rehabilitation in People With Lower Limb Amputation: A Systematic Review

The purpose of this paper is to identify the intervention components, key actors and models of social innovation that can contribute to the improvement of health rehabilitation services from a biopsychosocial perspective, aimed at people with lower limb amputation in a situation of disability. Likewise, it aims to analyze the ways in which Community Based Rehabilitation (CBR) facilitates the elimination of barriers in rehabilitation services and promotes a better quality of life for people with disabilities. A systematic review of scientific literature for the period 2001 to 2019 was carried out, starting with a bibliometric analysis of publications found in the Web of Science and Scopus databases; followed by content analysis with NVivo 12 software. Among the findings, it was identified that the optimization of health services for the population with disabilities in emerging countries requires investment and training. In addition, the success and deficiencies in CBR programs were analyzed, since according to the systematic review, these are limited to the care of people with lower limb amputation in contexts of armed conflict.

The Effect of Restorative Justice for Drug Users on The Overcapacity of Correctional Facility in Solo City

The problem of drug abuse has become a major challenge in many countries, causing the number of prisoners addicted to narcotics to increase and causing overcrowding in prisons. This article discusses the influence of restorative justice as an innovative solution in dealing with drug users and overcrowding in correctional facility. Restorative justice replaces the traditional punishment-focused approach with one that is oriented towards rehabilitation, reconciliation, and the active participation of drug users in the rehabilitation process. In addition, restorative justice can help reduce overcrowding in prisons by reassessing the detention approach to drug users. Alternatives such as community-based rehabilitation programs and electronic monitoring could be implemented to alleviate pressure on the overcrowded prison system. By combining restorative justice and prison reform, governments can create more sustainable and humane solutions to the complex challenges of drug addiction.

Disability and functional status among patients post Covid 19 - A tertiary care hospital based prospective study

BackgroundThe long-term sequelae of COVID-19 infection, the persistence of disability, its temporal profile, and associated factors remain under-documented in South India. ObjectivesTo estimate the proportion of disability in survivors of COVID-19 at different time points (first, second, and sixth months) and determine the demographic and clinical variables associated with poor functional status which will aid in developing effective treatment and rehabilitation strategies. MethodsA total of 139 COVID-19 patients were interviewed at discharge from a tertiary care hospital and followed up in the first, second, and sixth months. Persistent symptoms and post-COVID functional status (PCFS) scores were recorded at all these time points. Univariate and Multivariate Poisson regression analysis was used to determine the association of socio-demographic variables and other clinical factors with functional status post-COVID-19. Results48.92 % of patients had complete recovery. However, a majority (51.08 %) experienced persistent functional limitation - 33.81 % had negligible, 15.83 % mild, 0.72 % moderate, and 0.72 % severe limitation. Common symptoms at six months were breathlessness (23.02 %), fatigue (20.14 %), memory loss (10.07 %), myalgia (8.63 %), and post-traumatic stress disorder (7.91 %). Vaccination emerged as a significant predictor of disability status (p < 0.05). Taking two vaccine doses lowered the risk of disability by 0.48 times. ConclusionAt the six-month follow-up of discharged COVID-19 patients, they continue to exhibit persistent functional limitations and symptoms. Administration of two vaccine doses is recommended to improve functional status at six months. Multidisciplinary clinics, telemedicine, and community-based rehabilitation programs are essential to minimize post-COVID-19 functional disability and facilitate complete recovery.

"They Just Love Me"-An Examination of Social Support Experiences and Values Among People With TBI.

Social support is important for health and functional outcomes after traumatic brain injury (TBI), but many adults with TBI report inadequate social support. Little research has examined the social support priorities of adults with TBI or what an optimal social support network should include. The objective of this study was to describe the social support structures and experiences of adults with TBI. Community-based rehabilitation program. Community-dwelling adults with TBI, predominantly from racial and ethnic minority groups. Cross-sectional collection of quantitative and qualitative data. Number of close social contacts and total social contacts, along with a report of the frequency of social support using the Medical Outcomes Study Social Support Survey. Qualitative interviews were used to examine the quality of social support and participant values and priorities. Participants had an average of 4.3 close contacts (median 3.5, range 1-10), an average of 8.5 total social contacts (median 7, range 2-28), and a low frequency of social support (mean 28.4, SD=24.7). Interview themes fell under 2 grand themes: structure of social networks (social networks are made up of families; proximity influences the type of support) and quality of social support (commitment vs indifference; doing things with and for others adds meaning; and "they just love me"). Participants in this study had small social networks and a low frequency of social support. Findings suggest that people with TBI value committed support partners, social inclusion, bidirectional relationships, and emotional connection, yet experience lower support in these areas compared to tangible support. Future research should examine how to adapt existing models of social support to more closely align with participant values. Rehabilitation services may need to focus more heavily on individual and family training, addressing strategies to develop and maintain relationships, emotional connection, and communication to enhance relationship and social support quality.

Community-Based Drug Rehabilitation Clients’ Motivation, Satisfaction and the Factors Affecting their Completion of the Rehabilitation and Aftercare Program: A Convergent Mixed Methods Study

This study examined treatment motivation, clientele satisfaction, and the factors affecting enrollment and completion in community-based drug rehabilitation and aftercare programs in the Philippines. A convergent mixed methods research design was employed using a survey and qualitative focus group discussions. Both on-going and completed clients had high level of internal motivation towards treatment and were highly satisfied with the program. Clients reported internal and external factors influenced their completion of the rehabilitation program while their satisfaction determined the areas that require necessary improvements. Aside from internal and external motivation, the general structure of the program, competence of facilitators, government and community support, and complementary intervention serve as influential factors.

The Priority Goals and Underlying Impairments Contributing to Goal-Related Problems of People with Parkinson's Disease Receiving a Community-Based Rehabilitation Program.

Goal setting is a core rehabilitation practice in Parkinson's disease (PD). Targeting therapy towards specific goals leads to greater improvements in performance and psychosocial outcomes. Goal setting in PD is feasible, and although the nature of goals has been described in previous studies, the underlying impairments related to goals have not been described. Understanding the nature of goals ensures that interventions for people with PD are aligned with their needs and priorities. Understanding the underlying impairments highlights which symptoms have the biggest impact on daily life and is necessary for planning appropriate interventions to target them. To describe the nature of the goals of people with PD; the underlying impairments related to goals; and to compare differences between high and low priority goals. Deductive content analysis was used to map goal statements to the international classification of function (ICF) activity and participation category and to map therapist field notes detailing the primary underlying impairment to the ICF Body Functions category. These results were then compared across goal priority rankings. 88 goals of 22 people with PD were analysed. We found that people with PD set diverse goals across all chapters of the ICF Activity and Participation category, with "self-care" goals making up the highest proportion of goals. The primary underlying impairment related to the goals was predominantly related to impairments in "mental functions" under the Body Functions category. Regardless of goal priority, most goal-related underlying impairments were found to be in the "mental functions" category. The goals of this sample of community-dwelling people with PD highlight their diverse needs and priorities. These findings indicate that nonmotor symptoms, namely, executive dysfunction and amotivation most commonly impact the performance of and participation in activities of greatest importance to people with PD. This trial is registered with ACTRN12621001483842.

Answering the Rehabilitation 2030 Call.

In 2017, the World Health Organization initiated a global effort to improve rehabilitative services by 2030, with the overall goal of helping individuals with disabilities achieve maximal independence and improved well-being. Though more than 1 billion people worldwide live with a disability, a significant portion do not have access to appropriate rehabilitative services. In low-income countries, such as Zambia, where rehabilitative services are greatly lacking, disability can further exacerbate economic disparities in the context of personal, cultural, and environmental factors that limit participation in society. Therefore, expansion of rehabilitative services in low-income countries is a pressing global need, and such efforts must be tailored to the societal and cultural framework in which they are implemented. Community-based rehabilitation programs are uniquely poised to provide services in similar low-to-middle-income countries as they eliminate travel barriers to care, allow for regular follow-up, and address the societal determinants of disability by encouraging greater community engagement and by decreasing cultural stigma around disability. Special Hope Network (SHN), a community-based rehabilitation organization in Lusaka, Zambia that serves families caring for children with physical and cognitive disabilities, represents a cost-effective, sustainable, and culturally practical model to provide rehabilitative care. We propose this organization's model as one that can be reproduced and expanded upon in other low-to-middle-income countries to answer the World Health Organization's call to action.

Enhancing Community Resilience: An Integrated Home-based Psychological Intervention for Individuals Living with Physical Disabilities

Individuals living with physical disabilities more likely develop psychological problems and less able to seek appropriate care for their issues as compared with the individuals living without disability. This study aimed to assess the effectiveness of an integrated home-based psychological intervention in managing psychological problems among individuals living with disabilities. For the purpose, a total of 60 participants were enrolled from the Community-Based Rehabilitation (CBR) program at Aid to Leprosy Patients (ALP) in Rawalpindi Pakistan between November 2021 and July 2022. These participants received comprehensive rehabilitation services alongside a structured psychological intervention. The duration of the study was 5 months including the follow up sessions. Significant improvements observed from pre-treatment to post-treatment. The main effect for psychosocial disabilities was (F = 116.93, p&lt;.001), emotional problems (F = 116.93, p&lt;.001), Depression (F = 117.30, p&lt;.001), Anxiety (F = 150.02, p&lt;.001) and Stress (F = 93.36, p&lt;.001). The integrated home-based psychological intervention served as an effective rehabilitation approach for individuals with physical disabilities, particularly those previously unable to reintegrate into community life.

Adoption of community-based land rehabilitation programs (CBLRP) and its effect on livelihoods in Offa district, south Ethiopia

Land degradation is a major issue in Ethiopia and has a significant impact on agriculture and subsistence. Community-based land restoration projects are essential to address this issue. This study aimed to evaluate the implementation of a community-based land restoration programs and its impact on livelihoods in the Offa District of south Ethiopia. Four Kebeles were randomly selected for the study and 133 household heads (52 program participants and 81 non-participants) were selected using a simple random sampling method. Data was collected by using an interview schedule, focus-group discussions, and key informant interviews. Data were analyzed using a binary logistic regression model, propensity score matching, participation index (PI), t-test, and chi-square test. The results showed that the implemented land rehabilitation measures had higher crop production and farm income for most adopter households compared to their counterparts. The logistic regression model revealed that the slope of farmland, gender of household heads, family size, perception of rehabilitation, access to training, and farm experience positively influenced household participation in the community-based land rehabilitation programme (CBLRP) in the study area. However, the age of the respondents, access to education, size of farmland, frequency of extension contact positively and ownership of livestock negatively influenced household participation. Propensity score matching revealed that CBLRP resulted in higher crop output and farm revenue for most participating families than counterparts. Based on these findings, it is recommended that agricultural and rural development offices, non-governmental organizations, and other stakeholders should consider the factors that influence household participation in rehabilitation programs in the study area to effectively address the issue of the households’ participation at various levels of rehabilitation programs.