Community-based Rehabilitation Research Articles

Unmet rehabilitation needs in the first 6 months post-injury in a trauma centre population with moderate-to-severe traumatic injuries.

To describe the needs for subacute inpatient rehabilitation and community-based healthcare services, rehabilitation, and social support in patients with moderate-to-severe traumatic injury in the first 6 months post-injury. Further, to explore associations between sociodemographic and clinical characteristics and unmet needs. Multicentre prospective cohort study. Of 601 persons (75% males), mean (standard deviation) age 47 (21) years, admitted to trauma centres in 2020 with moderate-to-severe injury, 501 patients responded at the 6-month follow-up and thus were included in the analyses. Sociodemographic and injury-related characteristics were recorded at inclusion. Estimation of needs was assessed with the Rehabilitation Complexity Scale Extended-Trauma and the Needs and Provision Complexity Scale on hospital discharge. Provision of services was recorded 6months post-injury. Multivariable logistic regressions explored associations between baseline variables and unmet inpatient rehabilitation and community-based service needs. In total, 20% exhibited unmet needs for subacute inpatient rehabilitation, compared with 60% for community-based services. Predictors for unmet community-based service needs included residing in less central areas, profound injury severity, severe head injury, and rehabilitation referral before returning home. Inadequate provision of healthcare and rehabilitation services, particularly in the municipalities, resulted in substantial unmet needs in the first 6 months following injury.

Building an implementation strategy for community-based rehabilitation for mental health in Colombia.

Scientific evidence indicates that the community-based rehabilitation (CBR) model is recommended for recovery from mental disorders. However, this approach encounters barriers and often lacks implementation strategies. The aim of this study is to create a strategy for the implementation of CBR for mental health in Colombia through the identification of barriers and facilitators, together with the expected outcomes, from the perspective of mental health decision-makers in Colombia. This study adopts a qualitative descriptive approach, using focus group data collection methods and thematic analysis to code and analyze the data. A total of 208 individuals participated in the study, including mental health decision-makers and health care professionals. Intersectoral collaboration, contextualization, financial resources, and community commitment and autonomy were identified as barriers and facilitators. The element that was considered a priority for successful implementation was the contextualization of strategies. CBR needs to be strengthened through implementation science if these strategies are to be successfully developed and implemented in various contexts. http://links.lww.com/IJEBH/A210.

Community rehabilitation by the trained village health volunteers on activities of daily living and quality of life in stroke survivors

Background: The number of people with disabilities resulting from strokes is increasing in Thailand. The major sequela of the disease was weakness in one side of the body that causes difficulty in activities of daily living (ADL) and poor quality of life (QOL) for stroke survivors. Community-based rehabilitation could be one of the strategies that enhances functional performance and improves QOL in these individuals. There were many disabled people in Mae Ka subdistrict, San Pa Tong District, Chiang Mai Province, where health care providers and local people were enthusiastic to take care of each other’s health in the community. Objective: The present study aimed to investigate rehabilitation outcomes in ADL and QOL of stroke participants who received rehabilitation services from trained village health volunteers (VHVs). Materials and methods: This study was a quasi-experimental research design. Subjects were recruited using purposive sampling, including 10 stroke survivors. Instruments used were 1) ADL Assessment for Occupational Therapy Clients; and 2) World Health Organization Quality of Life Assessment, Short Form-Thai version. The statistics used were descriptive, as well as the Wilcoxon Signed Ranks Test. Results: Results demonstrated that scores of basic activities of daily living (BADL) in the participants increased significantly (p<0.05) except for sexual expression. The score in the instrumental activities of daily living (IADL) was also significantly higher at post-rehabilitation than pre-intervention (p<0.05), as was the total ADL score. Stroke patients had significantly higher QOL scores after intervention than the pretest (p<0.05). Conclusion: These indicated that the community rehabilitation center at Mae Ka Subdistrict Administrative Organization, San Pa Tong District, Chiang Mai Province, run by the trained VHVs could promote ability in daily activities and improve QOL in stroke participants who come for their services.

Health-related quality of life and associated factors among primary caregivers of children with cerebral palsy, in Bahir Dar and Gondar cities, Ethiopia, 2022.

Caring for a child with cerebral palsy (CP) could negatively affect the Health-Related Quality of Life (HRQOL) of the mothers who are usually the primary caregivers. To the best of our 'knowledge, there is a dearth of information on the HRQOL of primary caregivers of children with CP in Ethiopia. Therefore, this study aimed to investigate caregivers' HRQOL and factors associated with it in Gondar and Bahir Dar Cities, Northwest Ethiopia, 2022. A community-based cross-sectional study was conducted among primary caregivers of Children with CP from April 20 to June 20, 2022, in Gondar and Bahir Dar cities. Convenience sampling was used to get study participants. Data were collected by trained health extension and community-based rehabilitation workers. The collected data were coded, cleaned, entered into EPI data, and exported to Stata-16 for analysis. A generalized linear model was employed to show the relationship between dependent and independent variables. A P-value≤0.05 was considered statistically significant at a 95% confidence interval. In this study, HRQOL among primary caregivers of children with CP was 28.72(±13.38) and 23.26(±12.37) in the physical summary score (PSC) and mental summary score (MSC) respectively. Age 17-30yeas (p-value = 0.03), unable to read and write (p = 0.01), privately employed (p = 0.01) and government employed (p = 0.02), monthly income<1000 Ethiopian Birr (ETB) (p = 0.01), insufficient sleeping (p = 0.001), others relationship(p = 0.001), have three and above children (p = 0.001), others house composition (p = 0.003), have no helpers (p = 0.001) and third birth order of child (p = 0.03) were all factors associated with HRQOL in PSC. On the other hand, income<1000ETB (p = 0.05), insufficient sleeping (p = 0.001), others in relation to the child (p = 0.001), others in house composition (p = 0.03), dyskinetic CP (p = 0.01) and ataxic CP (p = 0.001) were all factors associated with HRQOL of caregivers in MSC components. The HRQOL among primary caregivers of children with CP in Bahir Dar and Gondar cities was low. Age, monthly income, educational status, sleeping status, relationship and house composition, number of living children, birth order of child, helpers, and type of CP were all significantly associated with HRQOL of primary caregivers of children with CP.

"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.

Experience of naturally occurring peer support among people using psychiatric day-care in China: an interpretative phenomenology approach.

China presently does not have an established peer support system, and the efforts of peer support workers are not acknowledged in the context of the growing global trend of community-based mental rehabilitation. This study aims to examine the first-hand experiences of persons who participate in psychiatric day-care facilities in Shanghai, China, and receive support from their peers. The goal is to gain a better understanding of how these informal peer support programs function and provide valuable knowledge for the establishment of more structured peer support programs that align with Chinese social culture. A total of 14 participants attending psychiatric day-care centres were selected for face-to-face semi-structured in-depth interviews using snowball sampling. The interviews took place between July 2021 and February 2022. The text data of the interview were acquired through transcription and then augmented using the interview scripts and additional resources. The data were analysed using interpretive phenomenological analysis until the themes reached saturation. A total of three overarching themes and eight corresponding sub-themes were produced: 1. reconstructing a social network: an ordinary interpersonal connection, becoming and conducting oneself, proceeding the process of adaptation in the company of peers; 2. balance and multiple roles within the relationship: selective self-exposure, managing proximity and distance; 3. sense of meaning and sense of community: supporting others while empowering oneself, love as expanding consciousness, advocating for the notion of group identity. This study is the initial examination of the contact and naturally occurring peer support that takes place among individuals in psychiatric day-care centres in China. The study's findings revealed that participants interact with others who have undergone similar conditions in the day-care setting, enabling them to rebuild an important social network. It is crucial to consider the possible benefits of peer support, assess the obstacles, and facilitate the personal recovery of individuals with mental disorders using the theory of recovery.

Level of Implementation of Drug Rehabilitation Program, Treatment and Intervention for Persons Who Use Drugs (PWUD) in Basud, Camarines Norte, Philippines

The study specifically assessed the level of implementation of the Drug Rehabilitation Program, treatment and intervention for Persons Who Use Drugs (PWUD) in Basud, Camarines Norte. It employed descriptive research where 300 respondents participated as respondents. As to the findings, in terms of community preparation PNP Basud initiates advocacy programs on drug education in the community. The least implemented practice was initiating activities in organizing screening for person who use drugs. Meanwhile, in terms of screening, it was found that MHO Basud initiates accomplishing intake form during the screening process. The least practice was initiating schedule check-up by MHO Basud. In terms of assessment, the results showed that MHO Basud ensures other assessment of other mental health conditions using mhGAP IG. The least practice, however, was ensuring request for laboratory/diagnostic test by the MHO Basud. In terms of implementation of intervention, it was revealed that MHO Basud implements community-based treatment for person who uses drugs. The least practice was implements inpatient treatment for person who uses drugs by MHO Basud. Finally, in terms of aftercare program, it was revealed that DILG Basud undertakes community reintegration for person who formerly uses drugs. The least practice, however, was ensuring follow-up for person who formerly uses drugs by the DILG Basud. Comprehensive community-based training programs and educational orientation on drug-related treatment, rehabilitation and interventions may be continuously provided to the implementers of interventions to raise public awareness on the essence, objectives and processes involved in community-based drug rehabilitation.

Needs for community-based rehabilitation services and support 12 months after moderate and severe physical traumatic injuries: a brief report.

Patients with physical traumatic injuries frequently require long-term rehabilitation services. To strengthen rehabilitation services in the post-acute phase, we need to assess characteristics of this population and their healthcare and rehabilitation needs in the community. This brief report summarizes the frequency of unmet rehabilitation needs in community-based rehabilitation during the first year after moderate and severe trauma. Additionally, the associations between sociodemographic, injury severity factors and unmet needs were examined. Data from a prospective multicenter cohort study of patients with moderate and severe trauma (New Injury Severity Score > 9) of all ages discharged alive from two regional trauma centers in 2020 were used. Needs were estimated using the Needs and Provision Complexity Scale. Overall, 46% of patients had unmet needs at 12 months post-injury, particularly related to the provision of rehabilitation services, specialist follow-ups, and social and family support. The probability of unmet needs was associated with age, pre-injury comorbidities, and impaired functioning. Our findings support strategies targeting younger patients, those with pre-injury comorbidities, and those with higher levels of disability and provide a starting point for the development of standardized rehabilitation needs assessment and guidelines following injury.

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.

Process evaluation of a maintenance pulmonary rehabilitation trial for people with chronic obstructive pulmonary disease.

The ComEx3 community-based extended maintenance pulmonary rehabilitation (PR) randomised controlled trial (RCT) aimed to determine the optimal strategy for maintaining the benefits of exercise for people with chronic obstructive pulmonary disease (COPD). We conducted a process evaluation of this RCT to determine if the trial was implemented per protocol, and to explore the barriers and facilitators of the trial, and mechanisms of impact. This was a mixed methods study consisting of analysis of PR class records, study diaries and interviews of those involved in the trial. We developed a reporting framework from available literature and performed a content analysis. Eleven of the 12 participants in the intervention group attended ≥70% of available classes before the trial was terminated due to the COVID-19 pandemic. Analysis of the study diaries found that adherence to the home exercise program was higher in the intervention than the control group. Analyses of interviews (n = 21) highlighted the complexity of standardising the processes across multiple sites, but revealed behaviour change amongst class physiotherapists who were able to conform with the required processes. Facilitators of participation included the desire to improve function and quality of life, while barriers included illnesses and lack of motivation. Mechanisms of impact included confidence in exercising and benefits from the education sessions. The ComEx3 RCT was implemented as planned largely due to commitment by the research team and the desire by patients to improve their quality of life by attending a PR program that they are familiar with. Successful implementation of PR RCTs requires good organisational skills, clear and consistent trial documentation, broad understanding of participant needs while being conscious of challenges experienced by people with COPD, and dedication by everyone involved in the RCT. SO WHAT?: This article shows the importance of running a process evaluation alongside an RCT. Although this RCT did not progress to completion, this process evaluation which was guided by a robust framework, will provide guidance for future interventions in this area.

Return to Work in Breast Cancer Patients following an Interdisciplinary Rehabilitation Program in a Community-Based Cancer Rehabilitation Center: A Pilot Study.

Despite curative treatment and discharge from acute hospital settings, breast cancer patients often have cancer- and treatment-related morbidity which impairs them from returning to work. Hence, the role of community-based return to work rehabilitation programs is important to help these patients transition back to work. This was a retrospective cohort study involving patients with breast cancer conducted at a community-based cancer rehabilitation center. Patients were involved in an interdisciplinary vocational rehabilitation program involving physiatrists, occupational therapists, physiotherapists and social workers. We recruited 63 patients for this study cohort, with 46 (73.0%) patients ≤ 60 years old. After undergoing the rehabilitation program, there were 37 (58.7%) participants who successfully returned to work. These participants returned to work at either within 6 months (27.0%), 12 months (29.7%) or 24 months (43.2%) after enrollment into the program, with a majority enrolling in white collar jobs. Multivariate regression analysis revealed that significant negative factors for return to work were advanced stage of cancer (p = 0.004), along with clinically significant fatigue, measured on the Brief Fatigue Inventory (p < 0.001). However, perceived work ability (p = 0.020) was found to be a positive factor.

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.

Stroke rehabilitation pathways during the first year: A cost-effectiveness analysis from a cohort of 460 individuals

BackgroundStroke burden challenges global health, and social and economic policies. Although stroke recovery encompasses a wide range of care, including in-hospital, outpatient, and community-based rehabilitation, there are no published cost-effectiveness studies of integrated post-stroke pathways. ObjectiveTo determine the most cost-effective rehabilitation pathway during the first 12 months after a first-ever stroke. MethodsA cohort of people in the acute phase of a first stroke was followed after hospital discharge; 51 % women, mean (SD) age 74.4 (12.9) years, mean National Institute of Health Stroke Scale score 11.7 (8.5) points, and mode modified Rankin Scale score 3 points. We developed a decision tree model of 9 sequences of rehabilitation care organised in 3 stages (3, 6 and 12 months) through a combination of public, semi-public and private entities, considering both the individual and healthcare service perspectives. Health outcomes were expressed as quality-adjusted life years (QALY) over a 1-year time horizon. Costs included healthcare, social care, and productivity losses. Sensitivity analyses were conducted on model input values. ResultsFrom the individual perspective, pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective, followed by pathway 1 (Rehabilitation Centre » Community Clinic). From the healthcare service perspective, pathway 3 was the most cost-effective followed by pathway 7 (Outpatient Hospital » Private Clinic). All other pathways were considered strongly dominated and excluded from the analysis. The total 1-year mean cost ranged between €12104 and €23024 from the individual's perspective and between €10992 and €31319 from the healthcare service perspective. ConclusionAssuming a willingness-to-pay threshold of one times the national gross domestic product (€20633/QALY), pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective strategy from both the individual and healthcare service perspectives. Rehabilitation pathway data contribute to the development of a future integrated care system adapted to different stroke profiles.

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.

Insights into the deployment of a social robot-augmented telepresence robot in an elder care clinic – perspectives from patients and therapists: a pilot study

AbstractAs the proportion of the elderly population in the USA expands, so will the demand for rehabilitation and social care, which play an important role in maintaining function and mediating motor and cognitive decline in older adults. The use of social robotics and telemedicine are each potential solutions but each have limitations. To address challenges with classical telemedicine for rehabilitation, we propose to use a social robot-augmented telepresence (SRAT), Flo, which was deployed for long-term use in a community-based rehabilitation facility catering to older adults. Our goals were to explore how clinicians and patients would use and respond to the robot during rehab interactions. In this pilot study, three clinicians were recruited and asked to rate usability after receiving training for operating the robot and two of them conducted multiple rehab interactions with their patients using the robot (eleven patients with cognitive impairment and/or motor impairment and 23 rehab sessions delivered via SRAT in total). We report on the experience of both therapists and patients after the interactions.

Community-Based Drug Recovery Program Social Services in Disruptive Times: Experiences of Person Who Use Drugs in Palawan, Philippines

The restricted movements during the COVID-19 pandemic have created challenges for people who use drugs (PWUDs) to access and complete community-based drug rehabilitation program (CBDRP) social services. This study aims to investigate the experiences of PWUDs undergoing CBDRP in Palawan, Philippines during disruptive times such as the COVID-19 pandemic with a focus on the changes in the social service support mechanisms enabling PWUDs to continue in their recovery. 188 PWUDs undergoing CBDRP in the 11 municipalities of Palawan participated in focus group discussions between July to December 2022. Participants were asked about the effects of the consequences of the COVID-19 pandemic such as social isolation; modification in the CBDRP social services delivery and accessibility; shifting focus of the CBDRP in-charge officers; and changing family dynamics. Transcripts were analyzed using thematic analysis and it revealed four themes: (1) Experiences of PWUDs on CBDRP social services support mechanisms as against as planned; (2) Challenges in completing CBDRP; (3) Leadership initiatives observed by PWUD; and (4) Role of local groups and PWUDs’ family in the recovery of PWUDs during COVID 19 pandemic. The study demonstrates a need for a holistic care approach with psychosocial needs support services; enhanced family and community engagement; sustainable livelihoods programs; digital transformation and digital engagement; and capacitating the social service providers particularly those at the barangay level and local groups as vital factors for better CBDRP delivery. Further, the study exposed the necessity for data-driven and context-specific policies flexible and agile enough to enable better social services delivery, community participation, and effective implementation. Keywords: community-based drug program, social services, person who uses drugs, COVID-19, public policy

Community-based rehabilitation services implemented by multidisciplinary teams among adults with stroke: a scoping review with a focus on Chinese experience

BackgroundDespite the growing interest in hospital rehabilitation services for communities, studies on existing community-based rehabilitation (CBR) services remain scarce owing to limitations in the development of community health services and regional cultural diversity. As a guaranteed measure for ensuring the quality of rehabilitation services and achieving the desired service outcomes, clear roles and responsibilities in multidisciplinary teams and effective service delivery are particularly important.ObjectiveThis scoping review aimed to determine the scope of community stroke rehabilitation programs involving existing multidisciplinary teams and to analyze the implementation content and implementers’ functional roles to provide guidance for future CBR programs.MethodsThe scoping review design followed the methodology of the Joanna Briggs Institute and was based on the normative scoping review framework proposed by Arksey and O’Malley. The comprehensive CBR framework was proposed by World Health Organization-guided data charting and analysis.ResultsOf the 22,849 identified citations, 74 studies were included, consisting of 6,809 patients with stroke and 49 primary caregivers, most of whom were from China. The most common working mode in CBR programs was a dual approach involving both healthcare professionals in medical institutions and community healthcare professionals. The number of programs in each discipline was in the following descending order: nursing, medical care, rehabilitation, psychology, nutrition, and public health. Among these, multidisciplinary teams comprising medical, nursing, and rehabilitation disciplines were the most common, with a total of 29 programs. Disciplinary members were mainly responsible for implementing their respective disciplinary content, with physicians providing guidance for the programs. More than 82.4% of the studies reported 2–4 intervention strategies. The intervention forms of rehabilitation content were the most diverse, whereas preventive interventions were more homogeneous than others. Physical function and socio-psychological measurements were the most commonly reported outcomes.ConclusionCBR services implemented by multidisciplinary teams can effectively achieve functional and emotional improvement in patients with stroke, and nurses are the most involved in implementation, especially in community settings. The results further emphasize the importance of strengthening the exploration of nurses’ maximum potential to implement CBR plans in future practice.Trial registrationThe registration information for this scoping review can be found at osf.io/pv7tg.

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.