Community based rehabilitation

Background: The aim of this study was to compare QOL among people in India using lower-limb prostheses or orthoses with people without disability. A further aim was to compare subgroups and investigate whether QOL was associated with physical disability, gender, income, living area, and education. Methods: A cross-sectional questionnaire study in which the World Health Organization Quality of Life-Bref was used to collect self-reported data. A total of 277 participants from India were included, 155 with disability and 122 without. Group comparisons were conducted using the Mann-Whitney U and the Kruskal-Wallis tests and associations were explored using regression analyses of the four QOL domains: physical health, psychological, social relationships, and environment. Results: Participants with physical disability scored significantly lower than did participants without disability in three of the four QOL domains, i.e., physical health, (Median 14.29 vs 16.29; p < .001) psychological, (Median 14.67 vs. 15.33; p = .017) and environment (Median13.00 vs 14.00; p = .006). For people with disability those with no or irregular income and those not attending school having the lowest QOL scores in all four domains. Education was associated with all four QOL domains and income was associated with psychological and environment. Living in urban slums was associated with a higher risk of lower QOL in three QOL domains, i.e., physical health, psychology, and environment. Conclusions: Despite rehabilitation services, people with physical disability experienced lower QOL in terms of the physical health, psychological, and environmental domains than did people without disability. Community-based rehabilitation programmes for prosthetic and orthotic users need to increase and improve their rehabilitation services to increase income and improve access to education. Priority could be given to those who have no or irregular income, live in urban slums, and have not attended school to further improve their QOL.

This paper examines how transhumanism, which advocates for the enhancement of human capacities through advanced technologies, alters and deepens our understanding of cultural identity, belonging, and maternal embodiment in Megan Hunter's The End We Start From. By reading the text by central terms of Rosi Braidotti, such as the "Nomadic Subject," and Stacie Alaimo, such as the "Transcorporeality" the study reveals that milk, amniotic memory, itself, rising waters establish a network of hydrological force that reconstructs agency: the protagonist is a giver that takes care, climate-refugee as well as an ecological (body) sensor. The broken syntax that painter Hunter employs helps to dissolve the distinction between the body and the world, indicating a maternal ethics of permeability rather than dominance. In the analysis, there are three major interventions: Postpartum Entanglement, where mothers' bodies are entwined with rivers, tidal disasters, and structural remains. Ecological Kinship in kinships involves mother, child, water, debris, and ruins. Nomadic Resilience, where Maternal Futurity is questioned, as an adaptive, non-linear survival, challenging the anthropocentric notion of refuge. By situating Hunter's story within the contexts of climate justice and reproductive labor discourses, this paper will demonstrate that The End We Start From develops a hydrofeminist politics relevant to the intersection of maternal affections and environmental health. The interdisciplinary nature of this inquiry provides significant contributions to environmental humanities and adaptation by showing how literary and filmic forms can express maternal climate ethics in its contribution to the development of ecofeminist posthumanism as a perspective through which human nonhuman inter-dependency can be found during the Anthropocene.

This study investigates the water quality and fish variety of Bhopal's Upper and Shahpura Lakes, two vital urban freshwater bodies that sustain local livelihoods and biodiversity. Using conventional netting methods, thirteen fish species were identified, including invasive Oreochromis mossambicus and native species like Labeo rohita and Cyprinus carpio. Important physico-chemical characteristics, such as pH, dissolved oxygen (DO), biological oxygen demand (BOD), hardness, alkalinity, and transparency, were measured in water samples taken from various locations. Even though the majority of the values fell below the CPCB/BIS-permissible limits, some regions displayed ecological stress, particularly Upper Lake Site II's raised pH and Shahpura Lake Site II's decreased clarity and pronounced organic odour. To preserve the biological integrity and biodiversity of these lakes, these findings emphasise the critical need for conservation initiatives, pollution control measures, and ongoing environmental monitoring.

Background: Childhood disability affects over 240 children worldwide, posing significant challenges to mobility, independence, and participation. Physiotherapy is the cornerstone of pediatric rehabilitation, aiming to enhance functional ability, prevent secondary complications and promote inclusion. Objective: This paper explores the roles of physiotherapy in supporting children with disabilities, highlighting its importance, evidence-based interventions, barriers to access and the need for integrated care approach. Methods: A narrative synthesis of current literature was conducted, drawing on global reports and peerreviewed studies to examine physiotherapeutic interventions, their effectiveness, and the systemic issues influencing service delivery. Results: Evidence demonstrated that physiotherapy intervention improves quality of life of children with disability. Early intervention leveraging neuroplasticityis particularly effective in improving long-term outcomes. However, significant disaprities persist, with children in low-and middle-income counties dacing barriers including workforce shortages, limited infrastructure, caregiver burden and sociocultural stigma, integrated family-centered models and community-based rehabilitation programs are shown to enhance accessibility and sustainability, while tele-rehabilitation offers emerging opportunities for service delivery. Conclusion: Physiotherapy is integral to the health and well-being of children with disabilities, offering both clinical and social benefits. Addressing inequities in access and embedding physiotherapy within inclusive, community-oriented frameworks are essential to maximize its impact. Strengthening evidence-based practice, early intervention, and policy support will further advance pediatric rehabilitation and promote the rights and inclusion of children with disabilities.

Introduction: Hygiene practices are essential for maintaining public health and preventing the spread of infectious diseases. Mass media has the potential to influence individuals' hygiene behaviors and attitudes, by reaching a wide and diverse audience simultaneously, mass media can effectively disseminate targeted hygiene-related messages, leading to improved knowledge. Therefore, the study aimed to assess the contribution of mass media to the adoption of good hygiene practices in Garba Tula sub-county. Methodology: The study employed a mixed method approach where the researcher incorporated both qualitative and quantitative approaches, with a sample size of 191, which included the household heads, public health officers, area chief, and religious leaders. The study was conducted between December 2022 and February 2023. The data was analyzed by use of SPSS (2022) and ANOVA. Results: The study identified media representation, lack of awareness, poverty, lack of water, and culture as some of the factors associated with poor hygiene practices in Garba Tula Sub County. The study found there was a moderate relationship (P=<0.001) between hygiene practices and the media. It was noted that a significant percentage of households depended on the media for hygiene messages. Conclusion: The study concluded that the physical parameters and opinion leaders significantly influenced the adoption of good hygiene practices in the Gabra-Tula sub-county. The study recommends that mass media be used exhaustively to aid in behavior change and creating awareness.

This paper aims to address the information gap on the influence of socio-demographic factors on access and utilization of Assistive Technology (AT) among children with disabilities in Malawi. Thus, it contributes towards the realization of the recommendations of the UN Convention on the Rights of Persons with disabilities and the development of a framework for creating an effective national AT policy. The paper used two statistically matched datasets, namely, the 2017 survey on Living conditions among persons with disabilities in Malawi and the 2015-16 Malawi Demographic and Health survey. Logistic regression and structural equation modeling techniques were utilized to assess the influence of socio-demographic factors on the use of AT among children with disabilities. The results indicate that there is a high level of unmet need for AT among young children aged 2 to 9 and those living in urban areas. The results further indicate that children with multiple disabilities have lower od...

Purpose: This article aims to present the role of community health workers in the implementation of a comprehensive CBR Programme in rural Mongolia, and to explore the main challenges that arise in this specific geographical and socio-economic context. Methods: Qualitative data were collected through semi-structured interviews with CBR workers from three selected provinces; short meetings and interviews with respective provincial level CBR coordinators complemented the information acquired. Additionally, a workshop with national level CBR stakeholders was carried out in order to review and discuss the findings. The study highlighted a number of practical barriers (including long distances and lack of transportation, low population density, and harsh climate conditions) which constrain the work of community health workers in the areas studied. In relation to disability, the study shed light on the difficulties found by community workers in shifting from a medical approach to disability to a new approach that emphasizes prevention and rehabilitation. Exploring interviewees' experience in the five areas of CBR (health, education, livelihood, social, empowerment) the authors found that working in the areas other than health is perceived as difficult due to insufficient training as well as objective contextual barriers. conclusions: Despite many challenges, CBR represents a significant improvement for disability action in rural Mongolia. In this context, the local community health workers are well suited and willing to act as CBR workers; nonetheless, more training and some tailoring work to adapt the Programme to the context is needed if all potential results are to be achieved.

Purpose: This article aims to present the role of community health workers in the implementation of a comprehensive CBR Programme in rural Mongolia, and to explore the main challenges that arise in this specific geographical and socio-economic context. Methods: Qualitative data were collected through semi-structured interviews with CBR workers from three selected provinces; short meetings and interviews with respective provincial level CBR coordinators complemented the information acquired. Additionally, a workshop with national level CBR stakeholders was carried out in order to review and discuss the findings. The study highlighted a number of practical barriers (including long distances and lack of transportation, low population density, and harsh climate conditions) which constrain the work of community health workers in the areas studied. In relation to disability, the study shed light on the difficulties found by community workers in shifting from a medical approach to disability to a new approach that emphasizes prevention and rehabilitation. Exploring interviewees' experience in the five areas of CBR (health, education, livelihood, social, empowerment) the authors found that working in the areas other than health is perceived as difficult due to insufficient training as well as objective contextual barriers. conclusions: Despite many challenges, CBR represents a significant improvement for disability action in rural Mongolia. In this context, the local community health workers are well suited and willing to act as CBR workers; nonetheless, more training and some tailoring work to adapt the Programme to the context is needed if all potential results are to be achieved.

Indonesia CBR use WHO CBR manuals was first implemented in Bandung in 1985. CBR is a strategy and program to achieve Community -Based Inclusive Development (CBID), where Persons With Disability (PWD) are fully included in all aspects of community life.. WHO estimate about 15% of the world's population are persons with disability. The research was conducted to know sustainability of

Purpose: This research study aimed to investigate the effectiveness of the services provided by CBR programmes in Jordan. Method: This was a mixed-methods investigation. A survey was carried out with 47 participants (stakeholders and volunteers) from four CBR centres in Jordan. It comprised 18 questions that collected both qualitative and quantitative data with both closed-and open-ended questions. The quantitative data were analysed using SPSS Version 22.0. Qualitative data were analysed through thematic content analysis and open coding to identify emergent themes. Implications: This study was inclusive of all types of disability. Barriers to the effectiveness of services may stem from accessibility issues to the families of persons with disabilities (hard to reach) or from CBR services themselves (hard to access). The culturally specific evaluative tool in this study was of "good" specificity and sensitivity, this evaluative instrument can be transferrable to measure the impact of CBR programmes in other settings.

Background: The main objective of this study was to review the goals and programs of rehabilitative care in different countries to achieve a framework for a national operational plan for expanding rehabilitation services in Iran. Methods: In this qualitative study (scoping review), national rehabilitation documents were reviewed in a selected list of countries. We searched several databases including Web of Science, PubMed, Scopus, and Google Scholar and main website such as WHO. Then, the review results were presented to a panel of experts to receive their feedback and opinion for a framework of national rehabilitation policy and strategies in Iran. Results: In the preliminary phase, 1775 documents were found and 17 documents were selected from Asia, Europe, three islands near Australia, America, and Australia continents. National policies and programs regarding rehabilitation could be categorized in three fields: 1) Removing the barriers to access rehabilitative health services, 2...

Introduction: The Integrated Child Development Service Scheme (ICDS) is one of the initiatives taken up by the Central Government to reduce the burden of illness and mortality among women and children. Anganwadi workers (AWW) play a key role in health education and care at the primary care settings especially in rural India for which adequate information about the physiotherapy is an important factor as physiotherapist plays a significant role in management of any kind of disability and community based rehabilitation. The present study has been undertaken with the objective to assess the knowledge of physiotherapy among AWW in Ziro, Arunachal Pradesh. Method: A cross sectional survey was conducted using a validated questionnaire among 50AWW. The data obtained were analyzed and described using tables. Result: This study shows that out of 89 participants, 76.4% respondents were not aware of the role of physiotherapy, 96.1 % were not aware of the techniques used in physiotherapy and none of the anganwadi workers were informed about physiotherapy during their training period. Conclusion: Awareness about physiotherapy among the AWW in Ziro who participated in this study was poor. Adequate awareness during training period about physiotherapy roles in various types of health care sector, its techniques and importance in community based rehabilitation will not just benefit the anganwadi workers and public, but also for the physiotherapy service deprived person with disabilities.

Introduction: Community Based Rehabilitation (CBR) is a strategy within community development for rehabilitation, equalizes opportunities and social integration of incapacitated people. This is a comprehensivestrategy of involving people with disabilities in their communities through the development program. CBR system provides for the people with disabilities equal access to treatment and rehabilitation, education, promotes health and healthy living, and also indicates the existence of other features that make these people become full members of society and the community in which they live and is currently used in over 90 countries around the world.Methods: Research was conducted in two CBRs (CBR-Kumrovec and CBR-Saraj Polje) in the department of physical medicine and rehabilitation in the Sarajevo Canton. The study included and statistically treated 97patients during the period from 01.01.2008 to 31.12.2008 year.Results: In a study from the total number of respondents 65% were wom...

Searching, sifting, abstracting, and assessing quality of relevant studies by three reviewers. Studies were evaluated for sample, design, intervention, threats to validity, and outcomes. A meta-analysis was not conducted because the studies did not address the same research question. Five studies and one systematic review were evaluated. Positive outcomes were reported for most training programs. Reviewed studies generally had small samples and poor design. The paucity of studies and lack of empirical precision in evaluating effectiveness necessitate future studies that are methodologically rigorous to allow confident recommendations for practice.

In 1995, the Japan Bank for International Cooperation (JBIC) had allotted considerable amount of financial aid to the Philippine government for rehabilitation projects of the critical watersheds in the country. Consequently, 55 project sites nationwide were funded for implementation under the JBIC Loan II (COA Report, 2006-07D). One of these is the Pulangi Watershed Rehabilitation Subproject (PWRS) in Bukidnon, implemented with funding support for the period 1996 to 2003. The PWRS had expended a total of Php 151.44 million covering four sites with a total aggregate area of 5,095.72 hectares of the Pulangi watershed (PWRS Terminal Report, 2003). The Pulangi area is one of the most important watersheds in Bukidnon primarily because it irrigates highly productive ricefields and generates 255 megawatts of electric power (PWRS Terminal Report, 2003). Based on the feasibility study, the project was economically feasible, having an Economic Internal Rate of Return (EIRR) at 26.3% and a net present value (NPV) of Php 13,300,258 at 12% discount rate (PWRS FS Report, 1995). As designed, the project was largely focused on biophysical rehabilitation implemented by local-based People's Organizations. The Community Environmental Development Management of Concepcion (CEDAMCO) Incorporated, is one of the cooperating PO's which implemented the CBFM-PWRS. It has a total active members of 152. It received a total budget amounting to Php 34.02 million covering, 1,498 hectares and consisting of five components, namely: reforestation, agroforestry, rattan, bamboo, and agrosilvipastural. More than half of the total amount was spent for reforestation component. The PWRS aimed to improve the ecological balance of the Pulangi watershed and to uplift the socioeconomic condition of the upland poor and underprivileged community members using the CBFM strategy/ approach. But despite CBFM's pro-poor approach, the achievement of the core objectives of social equitability and financial efficiency in forest development is constrained . The benefits of community forestry projects in the Philippines are captured by the elites . Apparently, there is a dearth of scientific investigation on the effectiveness of the PWRS in terms of addressing its core objectives (efficiency and equitability). Social programs such as PWRS are crucial to reduce poverty and inequity in the Philippines. In theory, the operation of social programs, is considered more socially sustainable if it meets two criteria: efficiency and equity; in other words, if the program can help more people who need it the most (Tirado et al.

The Japan Bank International Cooperation (JBIC) had poured-in substantial funding to the Pulangi Watershed Rehabilitation Sub-project (PWRS) for its rehabilitation. The Pulangi watershed in Bukidnon is essential for irrigating highly productive ricefields and generating electric power in Region 10. The PWRS aimed to improve the ecological balance of the watershed and to uplift the socioeconomic condition of the underprivileged community members using the CBFM strategy/approach. This study examined the financial efficiency and equitability of the PWRS implemented by the People Organization-Community Environmental Development Management of Concepcion (PO-CEDAMCO) Incorporated. The study used descriptive and analytical methods in collecting, organizing, and interpreting data. Financial efficiency indicators, namely household and farm income were analyzed and Net Present Value (NPV) of the project’s reforestation component was determined. Equitability was analyzed by determining the eve...

Objective: Group therapy involves multiple people being treated by one or more health professionals. It can cure physical and psychological conditions; such as attention-deficit/hyperactivity disorder (ADHD), emotional trauma, anxiety, despair, and post-traumatic stress disorder (PTSD). This study investigates whether community-based group therapy helps older women with chronic low back pain. Material and Methods: The study was a randomized controlled trial, with 40 patients divided into control and intervention groups. The control group received conventional treatment in an institute-based rehabilitation (IBR) facility, while the intervention group received the same exercise program in a community-based rehabilitation (CBR) setting. Both groups received supervised 30-minute sessions five days a week for eight weeks. The numeric pain rating scale (NPRS) was used to measure the severity of pain and the Roland-Morris Disability Questionnaire (RMDQ) measured physical disability due to low back pain in older women. Results: The average age of the participants was 56 (53 to 58.50). The BMI findings were 7.5% (n=3) of participants being underweight and 45% (n=18) of participants being overweight. In terms of pain and physical disability due to low back pain, the CBR group showed significant improvement (p-value<0.05) in cases of both inter-and intra-group comparison using the IBR treatment facility.

The study intended to explore as to what extend persons with disabilities (PWD) are included in sanitary accessibility, disaster management and prevention as well as in mitigating against environment hazards. To achieve this, the following questions were formulated; Are PWD rehabilitated or habilitated in environmental sustainability? Are they able to access community toilets and other hygiene services such as safe water? Do PWD participate in sanitary infrastructure development planning and programmes implementation? Descriptive survey method was used for this research and data was analysed in a narrative form. Convenient sampling and snow bowling method was used to select persons with disabilities and their families who participated in this study. Literature review showed that people with disabilities are among the most vulnerable and least equipped to deal with environmental hazards and impact of climate change in most African and Asian countries. The findings indicated that peop...

Co-supervisor: Mrs. L.B. van der Westhuizen (UNAM) DECLARATIONS I, Tonderai Washington Shumba, declare hereby that this study is a true reflection of my own research, and that this work, or part thereof has not been submitted for a degree in any other institution of higher learning.

The purpose of this study was to compare the lower extremity alignment during standing and step down task between normal weight and obese individuals. Methods: Two-dimensional lower extremity data in the frontal plane was obtained from 36 normal weight females (BMI 18.5 to 24.9 kg/m 2 ) and 36 obese females (BMI ≥ 30 kg/m 2 ). Pelvic adduction angle was defined as the angle between a line connecting the anterior superior iliac spines (ASIS) bilaterally and the frontal plane. Hip adduction angle was determined 90 • -θ. The θ angle was defined as the angle between a line connecting both ASISs and a line connecting the ASIS with the midpoint of knee joint. Knee valgus angle was defined as the angle between a line connecting the ASIS with the midpoint of knee joint and a line connecting the midpoint of knee joint and the medial and lateral malleolus. Pelvic adduction, hip adduction and knee valgus angles were analyzed using Kinovea software version 0.8.15. Independent-t test were used to compare the pelvic adduction, hip adduction and knee valgus angles between normal weight and obese during standing and step down task. The significance level were set at p < 0.05. Results: Obese subjects had significantly greater hip adduction angles than subjects with normal weight during standing (mean ± SD = 7.94 • ± 2.08 • , 6.83 • ± 2.54 • , p = 0.047), and during step down task (mean ± SD = 13.11 • ± 3.11 • , 11.31 • ± 3.17 • , p = 0.017), respectively. Moreover, pelvic adduction angles were significantly greater in obese females when compared to normal weight subjects during step down task (mean ± SD = 6.11 • ± 3.82 • , 4.25 • ± 3.37 • , p = 0.032), respectively. Knee valgus angles in obese females were significantly lower than those in normal weight females during standing (mean ± SD = 169.78 • ± 2.66, 174.39 • ± 2.38 • , p = 0.001), respectively whereas knee valgus angles in obese females were significantly greater than those in normal weight during step down task (mean ± SD = 181.83 • ± 8.07 • , 173.00 • ± 5.22 • , p = 0.001), respectively. Obese subjects show more hip adduction and knee valgus angles than normal weight subjects during standing whereas obese subjects demonstrate more hip adduction and less knee valgus than normal weight subjects during step down task. Implications: The use of step down task to be the functional performance test or the exercise in obese subjects should be considered more carefully than those in normal weight subjects.

Background: The aim of this study was to compare QOL among people in India using lower-limb prostheses or orthoses with people without disability. A further aim was to compare subgroups and investigate whether QOL was associated with physical disability, gender, income, living area, and education. Methods: A cross-sectional questionnaire study in which the World Health Organization Quality of Life-Bref was used to collect self-reported data. A total of 277 participants from India were included, 155 with disability and 122 without. Group comparisons were conducted using the Mann-Whitney U and the Kruskal-Wallis tests and associations were explored using regression analyses of the four QOL domains: physical health, psychological, social relationships, and environment. Results: Participants with physical disability scored significantly lower than did participants without disability in three of the four QOL domains, i.e., physical health, (Median 14.29 vs 16.29; p < .001) psychological, (Median 14.67 vs. 15.33; p = .017) and environment (Median13.00 vs 14.00; p = .006). For people with disability those with no or irregular income and those not attending school having the lowest QOL scores in all four domains. Education was associated with all four QOL domains and income was associated with psychological and environment. Living in urban slums was associated with a higher risk of lower QOL in three QOL domains, i.e., physical health, psychology, and environment. Conclusions: Despite rehabilitation services, people with physical disability experienced lower QOL in terms of the physical health, psychological, and environmental domains than did people without disability. Community-based rehabilitation programmes for prosthetic and orthotic users need to increase and improve their rehabilitation services to increase income and improve access to education. Priority could be given to those who have no or irregular income, live in urban slums, and have not attended school to further improve their QOL.

The primary goal in the developing field of community based rehabilitation (CBR) for individuals with TBI / ABI is community participation and integration. At present, CBR is less than clearly defined and is represented by a set of interventions with varied types, degrees of clinical support and models of intervention that are conducted for a diverse and complex set of individuals, situations, deficits and settings. Nonetheless, holistic neurorehabilitation programs should be considered both evidence based and a practice standard. This paper attempts to address some of the significant issues relevant to optimizing long term adaptation for persons receiving CBR. The article also addresses the current need for definitions, models, program classifications and comparisons, as well as programmatic methodologies by attempting to integrate some of the best scientifically supported methodologies within an eclectic holistic rehabilitation model that is easily understood and teachable to pers...

Care for most people with schizophrenia is best delivered in the community and evidence-based guidelines recommend combining both medication and a psychosocial intervention, such as community-based rehabilitation. There is emerging evidence that community-based rehabilitation for schizophrenia is effective at reducing disability in middle-income country settings, yet there is no published evidence on the effectiveness in settings with fewer mental health resources. This paper describes the protocol of a study that aims to evaluate the effectiveness of community-based rehabilitation as an adjunct to health facility-based care in rural Ethiopia. This is a cluster randomised trial set in a rural district in Ethiopia, with sub-district as the unit of randomisation. Participants will be recruited from an existing cohort of people with schizophrenia receiving treatment in primary care. Fifty-four sub-districts will be randomly allocated in a 1:1 ratio to facility-based care plus community...

Background: Outcome measures in physiotherapy are multi dimensional hence, may not estimate the individualized goals of patients with varying complaints. To make a quantitative, individual assessment of patients in a community is even more challenging. Therefore, assessment measure such as goal attainment scaling (GAS) acts as a better tool of measurement. Objective: To assess feasibility of goal attainment scaling (GAS) as used by physiotherapists in a community based rehabilitation setting. Method: This is a quantitative pilot study with pre and post intervention data evaluation using GAS. The author selected 10 consecutive patients, of different diagnosis, from referred patients waiting list and handed over to physiotherapists who gave informed consent to apply GAS scale. Results: A total of 10 patients data were collected. The mean age of patients was 80.4 years. Patients with lower quadrant complaints showed a marked improved in GAS scores. A total of 19 goals were identified , out of which 8 goals were achieved at expected level; 6 failed to reach the expected level and 5 were superseded the expected level of performance. Feedback from physiotherapists suggested that GAS is a useful measure for community based rehabilitation (CBR) in a low income setting. Conclusion: GAS proves to be a responsive measure in CBR setting. GAS provides clarity of goals for the physiotherapists, patients and hence,their families. GAS seems to have good psychometric properties but the concern with its use is therapist may set goals which are too easy to achieve for the patient. Further research is required to investigate its feasibility of GAS in Pakistan.

OBJECTIVESTo review the evidence evaluating the effectiveness of informal caregiver interventions to facilitate the recovery of older people discharged from the hospital.DESIGNSystematic review and meta‐analysis.SETTINGHospital and community.METHODSPublished and unpublished randomized and nonrandomized controlled trials assessing the effectiveness of informal caregiver interventions to support the recovery of older people discharged from the hospital were identified (to March 2019). The primary outcome was patient health‐related quality of life (HRQOL). Secondary outcomes included patient function, caregiver burden, caregiver HRQOL, psychological distress, adverse events, and health resource use. Studies were critically appraised and meta‐analyzed.PARTICIPANTSAdults who had been admitted to the hospital.RESULTSA total of 23 studies were eligible (4695 participants). The indication for hospital admission was stroke in 21 trials (91%). Interventions consisted of training and/or skills...

Background: Increasing incidences of cancer combined with prolonged survival have raised the need for developing community based rehabilitation. The objectives of the analysis were to describe and interpret the key issues related to coordination and coherence of community-based cancer rehabilitation in Denmark and to provide insights relevant for other contexts. Methods: Twenty-seven rehabilitation managers across 15 municipalities in Denmark comprised the sample. The study was designed with a combination of data collection methods including questionnaires, individual interviews, and focus groups. A Grounded Theory approach was used to analyze the data. Results: A lack of shared cultures among health care providers and systems of delivery was a primary barrier to collaboration which was essential for establishing coordination of care. Formal multidisciplinary steering committees, team-based organization, and informal relationships were fundamental for developing coordination and coherence. Conclusions: Coordination and coherence in community-based rehabilitation relies on increased collaboration, which may best be optimized by use of shared frameworks within and across systems. Results highlight the challenges faced in practical implementation of community rehabilitation and point to possible strategies for its enhancement.

Background: Increasing incidences of cancer combined with prolonged survival have raised the need for developing community based rehabilitation. The objectives of the analysis were to describe and interpret the key issues related to coordination and coherence of community-based cancer rehabilitation in Denmark and to provide insights relevant for other contexts. Methods: Twenty-seven rehabilitation managers across 15 municipalities in Denmark comprised the sample. The study was designed with a combination of data collection methods including questionnaires, individual interviews, and focus groups. A Grounded Theory approach was used to analyze the data. Results: A lack of shared cultures among health care providers and systems of delivery was a primary barrier to collaboration which was essential for establishing coordination of care. Formal multidisciplinary steering committees, team-based organization, and informal relationships were fundamental for developing coordination and coherence. Conclusions: Coordination and coherence in community-based rehabilitation relies on increased collaboration, which may best be optimized by use of shared frameworks within and across systems. Results highlight the challenges faced in practical implementation of community rehabilitation and point to possible strategies for its enhancement.

Background: Increasing incidences of cancer combined with prolonged survival have raised the need for developing community based rehabilitation. The objectives of the analysis were to describe and interpret the key issues related to coordination and coherence of community-based cancer rehabilitation in Denmark and to provide insights relevant for other contexts. Methods: Twenty-seven rehabilitation managers across 15 municipalities in Denmark comprised the sample. The study was designed with a combination of data collection methods including questionnaires, individual interviews, and focus groups. A Grounded Theory approach was used to analyze the data. Results: A lack of shared cultures among health care providers and systems of delivery was a primary barrier to collaboration which was essential for establishing coordination of care. Formal multidisciplinary steering committees, team-based organization, and informal relationships were fundamental for developing coordination and coherence. Conclusions: Coordination and coherence in community-based rehabilitation relies on increased collaboration, which may best be optimized by use of shared frameworks within and across systems. Results highlight the challenges faced in practical implementation of community rehabilitation and point to possible strategies for its enhancement.

Objective This paper explores the impact and mechanisms for successful implementation of a speech language pathology assistant (SLPA) role into a rehabilitation setting using a traineeship approach. Methods Multiple data sources were used, including interviews with key stakeholders, documentary evidence and a workload audit. Results The SLPA role increased clinical service capacity by 28 h per week across the service and required a total of 3 h per week of supervision input (the equivalent of 38 min per speech and language pathologist (SLP)). The SLPA used non-clinical time for training and administration. Mechanisms that facilitated the implementation of the SLPA role were: support for existing staff; formal knowledge and skills in training; consultation and engagement; access to a competency framework; close working with the registered training organisation; clearly defined role and delegation boundaries; clear supervision structures; confidence in own role; supportive organisatio...

Background: A hip fracture in older adulthood can result in function and mobility decline. The consequences are debilitating and place a great burden on patients, caregivers, and the health care system. Although inpatient rehabilitation programs have proven effective, the best practices for community-based rehabilitation required to maintain the gains in function and mobility post hospital discharge are currently unknown. Objective: The aim of this systematic review is to identify and evaluate the evidence on the effectiveness of community-based rehabilitation post hospital discharge interventions for older adults with cognitive impairment (CI) following a hip fracture, and to identify the physical recovery outcomes and measures used in previous studies. Methods: The methods outlined in the Cochrane Handbook for Systematic Reviews of Intervention were followed and findings were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search strategy included a combination of text words and subject headings relating to the concepts of CI, dementia, delirium, cognitive reserve, and hip fractures. For a study to be included in the review, it had to involve participants with CI who underwent hip fracture surgery, and consisted of an outpatient intervention that occurred in the participant's home or community. Peer-reviewed journal articles were identified by searching various databases. Two independent reviewers screened the titles and abstracts to determine which articles comprising of a rehabilitation intervention within a community setting prior to being included for a full article review. A data extraction form and an evidence and quality checklist were used during the full article data analysis and synthesis. A meta-analysis was not conducted due to heterogeneity of measures and outcomes. Results: The original search resulted in over 3000 articles. Of those, three studies satisfied the necessary criteria to be included in the systematic review. All studies included inpatient and outpatient physiotherapy, with some including a cognitive component, family education, and a discharge assessment. Conclusions: The findings from this review suggest that community-based rehabilitation post hospital discharge interventions show promising results towards improving various physical function outcomes, mobility, and activities of daily living for older adults with CI following a hip fracture. This review also demonstrates and discusses the current lack of outpatient rehabilitation interventions targeted towards older adults with CI post-hip fracture. Additionally, several substantive gaps that require attention to move this field forward are highlighted.

Background: Alcohol is one of the most widely used recreational drugs in the world however, over the last decade its consumption has become an increasing concern along public health policy makers and international development agencies. The Caribbean populace particularly has in recent times had challenges from alcohol abuse which has posed significant morbidity and mortality of all age groups. This research has its focus on alcohol consumption among young adults using Dominica as case study. To determine the prevalence of alcohol consumption in young adults in Dominica. Also, to determine the common reasons and influencing factors to start alcohol consumption in younger age groups in Dominica. A total of 73 respondents from the city of Roseau and its neighbouring villages who attended a health fair organised in All Saints University School of Medicine, Roseau, Dominica. The research was a cross sectional study that involved use of a questionnaire for the collection of data. The findings showed that 66.67% consumed alcohol with majority of them being males (73.91%). Onset for consumption was higher in the age group 16-20 years with reasons being: peer pressure, social activities, curiosity and adult influence. Again, the age group 16-20 years had the highest onset for alcohol consumption giving major reason of social activity (71.43%). The study showed that most common age to start consuming alcohol was between 16-20 years and common reasons to start included 'social activities' and 'peer pressure' for majority and for a few 'curiosity' and 'adult influence'. It becomes incumbent on the government, healthcare practitioners and other stakeholders to promote responsible drinking and discourage premature drinking. In conclusion, applying regression analysis, age is a predictor of alcohol consumption and for each unit increase in age, there is an average increase of 13% in alcohol consumption considering a constant gender among Dominicans.

ABTRACT Many persons suffering psychotic illnesses, such as schizophrenia, are largely untreated in low income countries. In these settings, most persons with severe mental illness live with their families. Thus, families play a particular critical role in determining whether a person with a psychotic illness will receive treatment and what the quality of treatment. Psychoeducation has proven to be extremely effective in helping families develop the knowledge and skills which is necessary to help their family members. Indonesia has a national policy to integrate the management of mental health problems into the primary health care system. However, in practice, such care does not implemented effectively. A preliminary study in primary health centers in two districts of Bantul and Gunung Kidul regency, Yogyakarta province, showed that there was very little or there is not any training for health care workers on diagnosis and treatment of psychotic disorder. This study was conducted to...

Information gaps hinder the management of psychotic patients. Incorporating mental health services into primary care might solve the problem. Health workers can be trained to provide psycho-education for caregivers of psychotic patients. This study was a two stage experimental study. In the first stage, 43 health workers were trained to provide a psycho-education for caregivers of psychotic patients. Next, 10 health workers were selected to provide the psycho-education. Participants were family caregivers of psychotic patients (n = 113) randomly assigned to control and intervention groups. Pre- and post-tests were conducted to assess the results. Statistical analyses were conducted using paired t tests and analysis of covariance (ANCOVA). The intervention group scored higher for Knowledge of Psychosis at post-test. Both groups showed significant increase of knowledge (paired t tests: P&lt;0.001; P&lt;0.001; respectively) and the increases were not significantly different between the...

Original Article IntroductIon Need for the project: Addressing the human resource gaps at the community level, Pim Kuipers and Huib Cornelige [1] have highlighted the need to understand the challenges that exist in community-based rehabilitation (CBR) approaches to disability management. The authors have stated that there is a need of looking at ways of addressing human resource issues in CBR. CBR staff should be adequately trained to play the role of enablers of persons with disabilities and the agents of change in their communities. Hasheem Manan et al., [2] in their systematic review of the effectiveness of alternative cadres in CBR, found a complete dearth of evidence regarding the effectiveness of alternative cadres in CBR. They recommended that more systematic reviews are needed on the training, performance and impacts of rehabilitation workers. They suggested that the development of a new cadre of rehabilitation staff could be a key component of all CBR programmes and could help to alleviate the deficit in human resources for health in many low-income countries. Khan et al. [3] studied the challenges to neuro-rehabilitation in developing countries and defined neuro-rehabilitation as an interdisciplinary and cross-sectorial approach to intervention that requires a collaborative and coordinated effort of diverse sectors, professions, patients and communities. They Background: This project was a collaboration between a community-based organization in rural India and a professional organization providing training and teletherapy support. The objective was to address the human resource gaps in rural areas for delivering therapeutic interventions to children with neurodevelopmental disabilities (NDD) in low-resource settings. Objective: To empower health workers in rural areas with the skills necessary to provide need-based therapeutic interventi ons to children with developmental disabilities through training and teletherapy. Methods: The project began with an initial training phase consisting of 10 online training sessions. This was followed by five additional need-based online training sessions over a 9-month period. Thirty-one children with NDD (15 girls and 16 boys) were enrolled and tracked using the Canadian Occupational Performance Measure (COPM). A total of 750 need-based therapy interventions, including physiotherapy, occupational therapy, and speech therapy, were provided by professional therapists via teletherapy. Results: The children showed significant improvement in the functional goals set from baseline to midline and end line. A one-way repeated-measures ANOVA test revealed a significant positive impact of teletherapy on the functional goals planned for the sample (P < 0.5). Conclusion: Teletherapy demonstrated a positive impact on achieving functional goals for children with NDD in rural Jharkhand. It is recommended as an effective model to address human resource gaps and provide family-centered therapeutic support in low-resource rural areas.

In 2018, the United Nations global report showed that people with disabilities, who make up 15% of the worlds' population, have poorer health and rehabilitation access (SDG 3). Without improving the needed person-centered health and rehabilitation services at household level, SDG 3 cannot be achieved. This includes addressing human resource shortages through training multi-skilled community based rehabilitation workers (CRWs) to build rural workforce capacity and enhance the lives of people with disabilities, particularly in LMICs where the need is higher but resources are lower. However, to date, there is no documentation and analysis of existing training and its scope for this workforce in LMICs. A situational mapping overview was undertaken to review the current status of rural rehabilitation training programs offered in Southern Africa for CRWs. CRWs are rehabilitation personnel, based in the home/community, who are not professionals (without a bachelor qualification) but render non-institutional rehabilitation and inclusive development in communities, under the supervision of rehabilitation practitioners. Information on these programs was obtained using a two-step process. Firstly, a descriptive list of university courses for rehabilitation workers offered in the Southern African countries was collected via an internet and literature search. Secondly, detailed information about the disability and rural rehabilitation courses was collected from the respective institutions and their designated websites. There are six training courses targeted at CRWs or disability practitioners with a disability focus being offered at universities in Southern Africa, five of these in South Africa and one in Zimbabwe. Additionally, four training courses are offered as online/open resources by global organizations and are self-directed with no accreditation. While other key competencies feature, none of these programmes' learning outcomes make direct reference to the Ned et al. A Situational Mapping Overview of Training rural practice context and its complexities in relation to disability and poverty. The situational mapping overview shows limited training targeted at CRWs in Southern Africa, to effectively facilitate rural rehabilitation, poverty reduction and social inclusion. There is a need for an articulated community-orientated rural training to respond to the unmet needs. This may require a different set of competencies and assessment standards for trainees as well as additional competencies for their supervisors and mentors.

In democratic South Africa, there has been a shift from the punishment of offenders to the rehabilitation approach and a change from prisons to correctional centres. Once someone becomes an offender, the person goes through rehabilitation and not punishment. This paper discusses the influence of the immediate environment on the rehabilitation of paroles in Brits area of NorthWest Province in South Africa, a poverty-stricken area with limited resources. A qualitative approach and an exploratory descriptive design were utilised to describe the parolees' experiences of parole in a low-resourced community. One-on-one in-depth interviews were used to collect data which were then analysed thematically and backed by existing literature. The findings of the study showed that environmental factors play a role in offending and rehabilitation of offenders in low-resourced areas. The paper makes critical recommendations for consideration by parole officials and researchers to facilitate the effective rehabilitation of offenders in low-resourced areas.

Community Based Rehabilitation (CBR) programmes aim to utilise the existing resources in the community for persons with disabilities. This paper describes the role of the Resource Information Centres (RICs) set up in the aftermath of the earthquake in Pakistan, as part of the CBR framework. The authors perused relevant literature and added inputs from their experience regarding the role of RICs. The majority of persons with disabilities are not aware of the facilities available in their local areas. The RICs could play a vital role in guiding them to access the existing facilities comprehensively. RICs also carry out a variety of activities that facilitate social integration of persons with disabilities.

IntroductionStroke survivors, once in the community, face challenges with their long-term rehabilitation care and present higher levels of loneliness, depression and anxiety than the rest of the population. A community-based performance arts programme, Stroke Odysseys (SO), has been devised to tackle the challenges of living with stroke in the UK. In this study, we aim to evaluate the implementation, impact and experiences of SO for stroke survivors.Methods and analysisScaling-up Health Arts Programmes: Implementation and Effectiveness Research (SHAPER)-SO aims to scale-up SO to 75 participants and 47 stakeholders, while simultaneously evaluating the effectiveness and implementation of the programme. The main research aim is to evaluate the implementation, effectiveness, impact and experiences of a community-based performance arts programme (SO for stroke survivors). This mixed-methods study will evaluate the experience and impact of SO on those participating using mixed methods (in...

Community-based rehabilitation (CBR) is a multi-sectoral strategy that addresses the human rights and inclusion of persons with disabilities. Justice is a core component within the social pillar of the CBR Matrix, however, there is limited understanding of how CBR and Community-Based Inclusive Development (CBID) programs are implementing this component globally. The CBR Global Network and partners facilitated five online dialogues in different regions of the world to understand current practices and the future of the field as it relates to justice, choice, and power in CBR/CBID. Analysis was completed both deductively and inductively, to explore the trends and issues and any similarities or differences in practice across the regions. Participants discussed (i) challenges in policy implementation and law enforcement; (ii) the role of CBR/CBID programs; (iii) the role of family (as both facilitator and barrier to accessing justice); and (iv) engagement of people with disabilities. Findings detail important experiences of the CBR/ CBID stakeholders around the globe, and may inform future funding, practice, and advocacy.

-based rehabilitation (CBR) is a multi-sectoral strategy that addresses the human rights and inclusion of persons with disabilities. Justice is a core component within the social pillar of the CBR Matrix, however, there is limited understanding of how CBR and Community-Based Inclusive Development (CBID) programs are implementing this component globally. The CBR Global Network and partners facilitated five online dialogues in different regions of the world to understand current practices and the future of the field as it relates to justice, choice, and power in CBR/CBID. Analysis was completed both deductively and inductively, to explore the trends and issues and any similarities or differences in practice across the regions. Participants discussed (i) challenges in policy implementation and law enforcement; (ii) the role of CBR/CBID programs; (iii) the role of family (as both facilitator and barrier to accessing justice); and (iv) engagement of people with disabilities. Findings detail important experiences of the CBR/ CBID stakeholders around the globe, and may inform future funding, practice, and advocacy.

Study design: Cross sectional follow-sup survey. Objective: To ascertain the factors influencing community reintegration, of individuals with spinal cord injury living in rural environment, and to suggest measures to enhance community participation. Setting: Bangalore, Karnataka, India. Methods: Thirty-five individuals who were admitted under Physical Medicine and Rehabilitation Department of St Johns Medical College Hospital and rehabilitated to their functional level based on their level of injury; individuals living in rural environment were included in the study. The study was conducted by means of a standardized questionnaire and environmental and home assessments carried out during follow-up home visits after 12 months of discharge from the hospital. The main outcome measures were Craig Handicap Assessment and Reporting Technique (CHART) and Craig Hospital Inventory of Environmental Factors (CHIEF). The home visits and assessments were carried out by a rehabilitation team, which consisted of community-based rehabilitation worker, medico-social worker, physiotherapist and occupational therapist, and headed by a physiatrist. Results: The findings of the study indicate a general decline in community re integration in terms of physical independence, mobility, occupation and social integration. Mobility issues were the greatest perceived barrier and economic issues also significantly influenced the community participation. Conclusion: Our study showed significant decline in community reintegration in subjects living in rural south India. Architectural and environmental barriers, poor socioeconomic status and comorbidities significantly affected the level of community participation.

The paper examined the challenges of policy implementation in Nigeria with a focus on inmate rehabilitation ideas in Nigerian correctional centres. Attempts to make prisons in Nigeria treatment or rehabilitation centres is not a recent phenomenon but the passage of the Nigerian Correctional Service Bill into law in 2019 was a watershed in the history of correctional rehabilitation in the country. In addition to the change of name to reflect rehabilitation as the goal of incarceration, Section 14 (1&2) of the 2019 Correctional Service Act provides for the rehabilitation of inmates as a core responsibility of the service. Using a desk research approach, the paper explored available information to examine the progress of inmate rehabilitation idea in Nigeria. However, challenges to effective policy implementation have negatively impacted the implementation of inmate rehabilitation policy in the country. Implementing effective inmate rehabilitation policies in Nigeria requires a holistic and sustained effort involving various stakeholders, including the government, non-governmental organisations and the community, staff training, assessment and classification of inmates, removal of legal and social barriers, improved funding, and improved collaboration with the non-governmental organisations.