A scoping review of 10 years of published literature on community-based rehabilitation

Abstract

Purpose: To identify the characteristics of peer-reviewed literature on community-based rehabilitation (CBR) in low- and middle-income countries published in English from 2003 to 2012. Methods: This scoping review involved a systematic search of electronic databases using specific keyword/subject heading combinations. Journal articles were included if they were published in English, used “CBR” as related to rehabilitation with persons with disabilities and not limited to high-income countries (HICs). Data were charted according to both pre-determined and emergent categories. A subset of articles was charted by two reviewers to ensure reliability of variables. Results: A total of 114 articles were included. Fifty-two articles presented empirical research and 49 were published in one of two journals. The articles represented CBR activity in 26 specific countries, although only two of these were in Europe and only one was in the Americas. Authors were predominantly affiliated at universities and in HICs. Conclusions: This scoping review identified and characterized a large pool of literature on CBR, facilitating its incorporation into research and practice. Future research should examine the engagement of persons with disabilities in creating CBR literature, and analysis of literature in languages other than English.

• Implications for Rehabilitation

• Community-based rehabilitation (CBR) has been promoted as a rehabilitation strategy of choice in low- and middle-income countries (LMICs), but it has been critiqued for lack of an evidence base.

• A large number (114) of peer-reviewed articles were published on CBR between 2003 and 2012.

• Just under half of these articles (45%) presented empirical research, indicating that the evidence base for CBR is growing but will benefit from continued, rigorous inquiry.

• Furthermore, researchers from LMICs appear to be largely under-represented in published CBR research, flagging the need to support LMIC partners to share their CBR research in peer-reviewed journals.

     

Prosthetic device provision to landmine survivors in Bosnia and Herzegovina: outcomes in 3 ethnic groups

Burger H, Marin?ek ?, Jaeger RJ. Prosthetic device provision to landmine survivors in Bosnia and Herzegovina: outcomes in 3 ethnic groups. Arch Phys Med Rehabil 2004;85:19-28.

Objective

To determine differences in prosthetic provision, use, and effectiveness among unilateral lower-extremity amputees from 3 ethnic groups in Bosnia and Herzegovina.

Design

Case series with a consecutive sample of patients seen in field clinics.

Setting

Multiple field clinics in Bosnia and Herzegovina from October 1998 to May 2002.

Participants

A total of 671 patients were examined, and information about their prosthetic history was recorded from observation or verbal responses. The majority of the amputations resulted from injuries inflicted by landmines.

Interventions

Not applicable.

Main outcome measures

Self-reported walking distance per day, prosthesis functionality (functional or nonfunctional as assessed by a physician and a prothetist), prosthesis status (broken or nonbroken as assessed by a physician and a prothetist), and employment status.

Results

Ethnic groups differed significantly in types of prostheses provided, functional status of the prostheses, and use of the prostheses for community ambulation.

Conclusion

Prosthetic devices and delivery of rehabilitation services for unilateral lower-extremity amputees differed between ethnic groups. Despite these differences, functional prosthetic devices increased mobility. Persons in all 3 ethnic groups with functional prostheses were more mobile than persons with nonfunctional prostheses. The employment rate was higher for people with functional prostheses.     

Rehabilitation Consumers' Use and Understanding of Quality Information: A Health Literacy Perspective

Magasi S, Durkin E, Wolf MS, Deutsch A. Rehabilitation consumers' use and understanding of quality information: a health literacy perspective.

Objectives

To explore consumers' use and understanding of quality information about postacute rehabilitation facilities.

Design

Thematic, semistructured interviews.

Setting

Two skilled nursing facilities and 2 inpatient rehabilitation facilities in a large Midwestern city.

Participants

Rehabilitation inpatients (n=17) with stroke, hip fractures, and joint replacements and care partners (n=12) of rehabilitation inpatients.

Intervention

None.

Main Outcome Measure

None.

Results

Health literacy imposed barriers to participants' understanding of quality information. Using the Institute of Medicine's Health Literacy Framework, we identified specific barriers that limited participants' abilities to (1) obtain quality information, (2) process and understand quality information, and (3) make appropriate decisions about the quality of a rehabilitation facility. Participants tended to rely on informal and nonquality information when choosing a rehabilitation facility.

Conclusions

Given the barriers imposed by low health literacy, rehabilitation providers have a responsibility to present quality information in a way that consumers, especially those with low health literacy, can use and understand.     

An emancipatory research on CBR and the barriers faced by persons with disabilities

Abstract

Purpose: The aim of this research was to understand the barriers faced by persons with disabilities in their daily lives and the role of CBR projects in overcoming them. Method: A group of persons with disabilities involved in CBR activities was identified and trained in participatory research methodologies. Research was carried out, with support from a scientific advisory group, through sharing of life stories in residential meetings focusing on specific themes. These meetings were attended by 368 persons with disabilities. Results: The barriers identified ranged from isolation, neglect, abuse and violence to lack of access to social, health, education and livelihood opportunities. People faced their first barriers in their own families. Families also played an important role in overcoming some barriers at the individual level. CBR projects assisted people in overcoming barriers mainly by providing information, by facilitating access to existing support and by helping persons in communities to take collective action against the barriers. The research also stimulated DPOs and CBR projects to identify some gaps in tackling the barriers and to start action to overcome them. Conclusions: CBR projects can play a role in overcoming some barriers faced by persons with disabilities. Emancipatory research yields rich data, facilitates ownership and possibly future sustainability.

• Implications for Rehabilitation

• Community-based rehabilitation (CBR) programmes can promote mainstreaming and helping in overcoming some barriers faced by persons with disabilities in the communities.

• CBR programmes can facilitate collective action by persons with disabilities in overcoming barriers to inclusion and participation.

• Participatory research approaches such as emancipatory research can play a role in understanding disability issues and at the same time, help CBR programmes to identify gaps and strengthen activities.

     

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

Purpose: To identify the most common and most valued outcomes of community-based rehabilitation (CBR) in Chinese communities and to map these to the CBR evaluation framework.

Method: A multiple, embedded case study design was used. Four CBR programmes in China met the criteria for inclusion and participated. Data collection, via participant “story telling”, followed the procedures of the most significant change technique (MSC) over a period for five months. Content analysis with thematic coding was used to detect the common significant changes described in “top-rated” stories and in the entire pool of stories. Meta-analysis using the CBR framework was carried out to enrich the understanding of programme outcomes.

Results: A total of 101 stories were collected in the two rounds of story collection from the four programmes. Aggregated results demonstrated that, across all programmes, 78.21% of stories focused on changes in people with disabilities, 9.9% described aspects of programme development, 8.91% reported on outcomes related to CBR workers, and only 2.97% were focused on advocacy. When mapped against the elements of the CBR framework the MSCs among these four programmes were (1) psychosocial changes, (2) increased family participation and (3) improved physical functioning.

Conclusions: CBR practice in Chinese communities remains orientated towards an approach of functional rehabilitation rather than community-based inclusive development.

• Implications for rehabilitation

• Community-based rehabilitation is a strategy for community-based inclusive development.

• Commonly reported significant outcomes of community-based rehabilitation programmes in China focus on changes in psychosocial and physical status of people with disabilities and family participation.

• Community-based rehabilitation in China continues to focus on traditional rehabilitation. New efforts and directions are needed to also include goals of equity and community inclusion.

• Further efforts to promote the use of CBR guideline with the goal of facilitating inclusion and equal participation are strongly recommended.

     

Article 6: Rehabilitation practitioners’ perspectives on research utilization for evidence-based practice

Objective: To explore rehabilitation practitioners’ perspectives on barriers and solutions related to research utilization for evidence-based practice. Design: Focus group study. Setting: Conference room. Participants: 13 rehabilitation practitioners (occupational therapists, physical therapists, speech-language pathologists). Intervention: Participants discussed the barriers that prevented them from effectively using research information for evidence-based practice, and ways that they thought would help improve the usability of research information. Main Outcome Measures: Transcribed and coded verbal responses. Results: Top barriers included research topic not relevant to practice, sample not relevant to practice, lack of explanation for practical application, researchers’ lack of real-life knowledge about clinical situation, and presentation of research in article format not user-friendly. Practitioners also suggested ways to help alleviate those barriers. Conclusion: Rehabilitation researchers may need to rethink the way they conduct and report research in order to make information more usable, and thus increase utilization, for evidence-based practice. Although definite conclusion cannot be drawn from the present study due to its preliminary nature, the findings strongly indicated the need for future research about the issue of research utilization, which has not been adequately studied in the rehabilitation community.     

The emerging HIV epidemic among men who have sex with men in southeastern Europe

Patterns of HIV transmission in the seven countries of southeastern Europe (Albania, Bosnia and Herzegovina, Croatia, Montenegro, former Yugoslav Republic of Macedonia, Serbia and Slovenia) indicate that men who have sex with men (MSM) bear the highest burden of HIV. In 2008, MSM represented 56% of all HIV cases reported in Serbia, and 71 and 76% in Slovenia and Croatia, respectively. In other countries the number of reported HIV cases attributed to MSM remains low, which is likely due to under reporting. HIV prevalence measured in surveys was the highest among MSM compared with other at-risk groups, ranging from 0.7% in Bosnia and Herzegovina to 6.1% in Serbia. Data on sexual behaviors and HIV testing uptake indicate an urgent need to increase coverage with prevention services.     

The emerging HIV epidemic among men who have sex with men in southeastern Europe

Patterns of HIV transmission in the seven countries of southeastern Europe (Albania, Bosnia and Herzegovina, Croatia, Montenegro, former Yugoslav Republic of Macedonia, Serbia and Slovenia) indicate that men who have sex with men (MSM) bear the highest burden of HIV. In 2008, MSM represented 56% of all HIV cases reported in Serbia, and 71 and 76% in Slovenia and Croatia, respectively. In other countries the number of reported HIV cases attributed to MSM remains low, which is likely due to under reporting. HIV prevalence measured in surveys was the highest among MSM compared with other at-risk groups, ranging from 0.7% in Bosnia and Herzegovina to 6.1% in Serbia. Data on sexual behaviors and HIV testing uptake indicate an urgent need to increase coverage with prevention services.     

Prebirth psychosocial factors as predictors of consistency in contraceptive use among Taiwanese adolescent mothers at 6 months postpartum

OBJECTIVE: To assess contraceptive behavior and whether pre-birth psychosocial factors could predict consistency in contraceptive use among adolescent mothers at six-month postpartum. DESIGN: Prospective study. SAMPLE: 104 Taiwanese adolescent mothers. MEASUREMENTS: Participants completed a contraception questionnaire in their third trimester and a postpartum contraception questionnaire at six-month postpartum. RESULTS: Prior to giving birth, the adolescent mothers most commonly answered that condom use (39.8%) was the contraceptive method they planned to use after delivery. It was also more commonly reported in the postpartum to be the method they actually were using (54.3%). Stepwise logistic regression analysis further showed that a more positive contraceptive attitude (odds ratio=1.104) and a higher self-efficacy (odds ratio=1.068) in contraceptive use in the pre-birth period increased the probability that a participant would report that she always used contraceptives in the postpartum period. Nevertheless, a higher score in the pre-birth period in the area of subjective contraceptive norms (odds ratio=0.978) decreased this probability. The final regression model could correctly classify 81.7% of the participants. CONCLUSIONS: Health care professionals should provide adolescent mothers with the information they need to improve their attitude and self-efficacy toward contraception before they enter the postpartum period.     

Poster 2: When are deconditioned patients ready for acute rehabilitation?

Objectives: To assess ability of a medical acuity screening protocol to classify accurately deconditioned patients at risk for medical disruptions of acute rehabilitation. Design: Prospective comparison of 2 equivalent samples of consecutive admissions, 2 months apart, each divided into medically stable and unstable groups before admission. Setting: Acute rehabilitation unit, community hospital. Participants: 30 consecutive adult admissions to acute rehabilitation for deconditioning between September 25, 2000, and November 29, 2000; and 31 between February 1, 2001, and April 30, 2001. Interventions: Deconditioned rehabilitation candidates were screened for medical instability (protocol available), grouped as medically stable or unstable, reviewed with a physiatrist, and tracked prospectively. First sample findings were discussed with admitting physiatrists in multidisciplinary teams before the second sample. Main Outcome Measures: Planned completion of acute rehabilitation versus unplanned discharge due to acute medical setback, and length of rehabilitation stay. Results: Admission medical stability was associated with subsequent acute medical setbacks (Fisher exact test, P=.004). Medically unstable admissions had 6:1 odds of a medical disruption. Predictive success was associated with days from acute hospital to rehabilitation admission (Fisher exact test p=0.01). All predictive errors occurred with patients admitted to rehabilitation in less than 18 days from hospital admission. Medical disruptions of acute rehabilitation declined from the first (38.7%) to the second sample (16.7%). Conclusions: Data-driven team consensus about preadmission medical acuity screening preceded a decline in medical disruptions of acute rehabilitation among deconditioned patients.     

Feasibility of Computerized Adaptive Testing for Collection of Patient-Reported Outcomes After Inpatient Rehabilitation

Objective

To evaluate the feasibility of computer adaptive testing (CAT) using an Internet or telephone interface to collect patient-reported outcomes after inpatient rehabilitation and to examine patient characteristics associated with completion of the CAT-administered measure and mode of administration.

Design

Prospective cohort study of patients contacted approximately 4 weeks after discharge from inpatient rehabilitation. Patients selected an Internet or telephone interface.

Setting

Rehabilitation hospital.

Participants

Patients (N=674) with diagnoses of neurologic, orthopedic, or medically complex conditions.

Interventions

None.

Main Outcome Measure

CAT version of the Community Participation Indicators (CAT-CPI).

Results

From an eligible pool of 3221 patients, 674 (21%) agreed to complete the CAT-CPI. Patients who agreed to complete the CAT-CPI were younger and reported slightly higher satisfaction with overall care than those who did not participate. Among these patients, 231 (34%) actually completed the CAT-CPI; 141 (61%) selected telephone administration, and 90 (39%) selected Internet administration. Decreased odds of completing the CAT-CPI were associated with black and other race; stroke, brain injury, or orthopedic and other impairments; and being a Medicaid beneficiary, whereas increased odds of completing the CAT-CPI were associated with longer length of stay and higher discharge FIM cognition measure. Decreased odds of choosing Internet administration were associated with younger age, retirement status, and being a woman, whereas increased odds of choosing Internet administration were associated with higher discharge FIM motor measure.

Conclusions

CAT administration by Internet and telephone has limited feasibility for collecting postrehabilitation outcomes for most rehabilitation patients, but it is feasible for a subset of patients. Providing alternative ways of answering questions helps assure that a larger proportion of patients will respond.     

Nurses and Internet health information: a questionnaire survey

AIM: This paper is a report of a study to identify the extent of postgraduate nursing students' information literacy skills in relation to electronic media and health information and barriers to accessing this information. BACKGROUND: The Internet is a key source of information for a significant group of patients. However, there is evidence of quality issues with some Internet health information sites. Nurses need to be aware of the range and quality of online health information so as to assist patients and families to locate and evaluate relevant and current information. METHOD: A questionnaire designed to collect quantitative and qualitative data was posted to a convenience sample of all students enrolled in a postgraduate nursing programme in December 2005. The response rate was 55.1% or 123 responses. RESULTS: Most respondents had Internet access at home and work and believed that access to online health information resources had improved their practice. However, some had difficulties in accessing computers at work and insufficient time to search for online health information. Concern was expressed about the quality of online information, but the majority of respondents did not assess patient use. Frequent users of online resources were more likely to assess patient use. CONCLUSION: The development of nursing competencies in accessing and using online resources is a key precursor to supporting patients and families' use of the medium. Access to Internet resources at work, along with training and time for searching, is necessary for the development of skills enabling effective use of information technology.     

An evaluation of internet sites for burn scar management

Patients rely on the Internet for medical information. It is difficult to discern which resources are accurate or appropriate for patients. The purpose of this study was to develop a quality-assessment tool for health Internet Web sites and to apply this tool to assess the quality of burn scar management information on the Internet. Between September and December 2001, we prospectively evaluated all Web sites on the Internet search engine Yahoo! containing the headings "burn scar management," "burn scar healing," "burn scar treatment," and "burn scar therapy." The quality of each Web site's medical information was evaluated using our scoring system consisting of the following two components: quality and technical characteristics. The total score for each Web site was converted to a percent grade (eg, > or =80% = excellent, 70 to 79% = very good, 60 to 69% = good, 50 to 59% = fair, and <50% = poor). The Web sites were grouped into three categories: commercial (for profit), academic (university, hospital), and organizational (nonprofit). Of 88 Web sites evaluated, the majority 68 (77%) were commercial, 7 (8%) academic, and 13 (15%) organizational. Burn scar management information on the Internet was poor in the majority (79%) of commercial Web sites and was excellent, very good, or good in the majority of academic (86%) and organizational (77%) Web sites. Using our health information evaluation, we found that the majority of burn scar management information on the internet (77%) was of fair or poor quality. Academic and organizational Web sites had the best quality of burn scar management information. Additional testing of the developed tool will be needed to analyze the reproducibility of the results and their applicability in other medical domains.     

Parental perceptions of barriers to physical activity in children with developmental disabilities living in Trinidad and Tobago

Abstract

Background: Parents have a strong influence on their child’s engagement in physical activities, especially for children with developmental disabilities, as these children are less likely to initiate physical activity. Knowledge is limited regarding parents’ perceptions of this phenomenon in low- and middle-income countries (LMICs); yet many rehabilitation providers work with children with developmental disabilities and their parents in these contexts. Purpose: The aim of this study was to explore the barriers perceived by parents of children with developmental disabilities to their children’s engagement in physical activity. Methods: An occupational perspective was used to explore how parents speak about barriers to their child’s engagement in physical activity. Interviews were conducted with nine parents in Port-of-Spain, Trinidad and Tobago. Findings: Parent’s perceived barriers were categorized into four themes: family priorities, not an option in our environment, need to match the activity to the child’s ability, and need for specialized supports. Conclusions: Findings provide opportunities for future rehabilitation and community programming in LMICs.

• Implications for Rehabilitation

• Children living with a developmental disability may engage more in solitary and sedentary pursuits as a result of parents choosing activities that do not present extensive social and physical demands for their child.

• Therapists can play an important role in providing knowledge to parents of appropriate physical activity and the benefits of physical activity for children with developmental disabilities in order to promote children’s participation.

• In environments where there is limited social support for families, therapists need to consider and be particularly supportive of parental priorities and schedules.

     

Community-based rehabilitation programme as a model for task-shifting

This article explores some of the implications of a non-governmental organisation (NGO) initiated community-based rehabilitation (CBR) programme, for HIV-related task-shifting programmes which have been recommended by the World Health Organisation (WHO) as an important aspect of HIV prevention, treatment and care programmes. The CBR programme is run by multi-skilled community rehabilitation facilitators (CRFs) in a low income, rural context in KwaZulu-Natal, South Africa, and explicitly recognises the multiple facets of disability. As such, the programme focuses on both the physical and social aspects of living with disabilities. A qualitative approach was used to conduct this study, and semi-structured interviews were conducted with beneficiaries of the programme (n?=?35), home and community-based care givers (HCBCs) (n?=?13), and managers (n?=?2). A focus group discussion was conducted with CRFs (n?=?5). We found that the CBR programme successfully delivered rehabilitation services at a community level and that multi-skilled CRFs are an effective means of implementing CBR programmes in low-income rural areas. The developmental focus of the programme created a range of benefits for people with disabilities, including: physical rehabilitation, emotional support and counselling, access to grants, social inclusion and accessing assistive devices. Central to the programme's success was the maintenance of relationships and partnerships at different levels in the community, these included relationships between HCBCs and CRFs, between CRFs and therapists, and between the NGO and the various participants in the programme. However, the NGO struggled to maintain a partnership with the relevant government departments and this had important implications for the programmes sustainability. In conclusion, we argue that this programme's use of multi-skilled mid-level workers who have undergone effective training programmes in CBR demonstrates that a wide range of rehabilitation activities can be effectively undertaken at a community level, and that this programme provides an important example of how the WHO's task-shifting guidelines for HIV treatment, care and prevention can be implemented.     

影响脑卒中患者日常生活活动能力社区康复效果的相关因素

目的探讨影响脑卒中患者日常生活活动能力（ADL）社区康复效果的相关因素。方法202例脑卒中患者随机分为社区康复组103例和对照组99例，社区康复组进行康复治疗和随访，包括对高危因素的药物控制、康复治疗、卫生宣教、心理疏导等，对照组只进行随访。于入组时和治疗5个月后，应用巴氏指数（BI）、神经功能缺损量表及综合功能评定（FCA）中的认知项，对两组患者进行评定。将所有患者最后一次ADL评分作为因变量，分组情况、病程、高血压、高血脂、糖尿病、吸烟、发病部位、文化程度、性别、年龄、饮酒、睡眠质量、FCA认知功能（入组时）、FCA运动功能（入组时）、BI（入组时）、神经功能缺损程度评分（入组时）做为自变量，进行多元回归分析。结果分组情况、发病前是否饮酒、病程（入组时间早晚）、神经功能缺损评分及综合功能评分（运动功能和认知功能）与患者日后的ADL恢复存在相关性。结论早期社区康复治疗对提高脑卒中患者的ADL作用显著；认知障碍对患者的ADL有显著影响。     

基于信息技术的社区康复工作模式

社区康复是在社区内为残疾人提供多层面的策略,最终实现包融性社区发展,是三级康复服务体系的基层终端。本文结合文献分析国内社区康复的现状,参考国际社区康复理念,讨论存在的问题。提出借助网络信息技术,探索新的社区康复工作模式。     

Perceived barriers to mental health service use among individuals with mental disorders in the Canadian general population

BACKGROUND: Eliminating barriers to care is important for improving health service use. However, the barriers to mental health care have not been well investigated. OBJECTIVES: This study was designed to provide information about the barriers to mental health service use and to identify clinical factors associated with perceived barriers among individuals with depressive-, anxiety-, and substance use-related disorders in the communities. DESIGN: A cross-sectional analysis using data from the Canadian Community Health Survey-Mental Health and Well-being was instituted. SUBJECTS: Participants with depressive-, anxiety-, and substance use-related disorders in the past 12 months, assessed by the World Mental Health-Composite International Diagnostic Interview, were included (n = 4094). RESULTS: In participants with mental disorders, 19.5% reported barriers to mental health service use. The percentage of perceived barriers due to acceptability was higher than those for barriers due to accessibility and availability. Participants with comorbid mental disorders were more likely to have experienced barriers than those with one disorder in both mental health service users and in the nonusers. Role impairment was a significant factor predicting barriers to care, overall and in the service nonusers, in the groups having anxiety disorders only, having any depressive or anxiety disorders, and having any alcohol or drug dependence. CONCLUSIONS: Clinical characteristics play an important role in perceiving barriers to mental health care. Future efforts should pay particular attention to the needs of those with chronic and severe mental health problems and focus on improving the effectiveness of mental health services.     

The information requirements of people with cancer: where to go after the "patient information leaflet"?

Information is crucial for people with cancer for both successful treatment and rehabilitation and to facilitate user involvement and informed decision making. Research has tended to concentrate on biomedical sources, such as hospital-produced information. There have been few inductive investigations of patients' use of information available outside this environment, despite the media and Internet being identified as pervasive sources of cancer information. This article reports on a study that utilized naturalistic inquiry to explore the extent and manner in which the media and Internet are utilized as information sources by people with cancer. Results confirm that the media was used considerably by the study sample and was an important contributor to knowledge and facilitator for decision making. Participants were not passive receivers of media messages but interpreted it depending on their particular needs or their rating of the media source. Consumption of media-produced information was constrained by certain factors, such as the participants' physical inability to access sources, and needs were not always satisfied because media discourse and "newsworthiness" restricted the reporting of what was sought. The study highlights the importance of the media and Internet as an information source for people with cancer and calls for a greater awareness of this phenomenon.