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Lancet (London, England) Dec 2021Rehabilitation has often been seen as a disability-specific service needed by only few of the population. Despite its individual and societal benefits, rehabilitation...
BACKGROUND
Rehabilitation has often been seen as a disability-specific service needed by only few of the population. Despite its individual and societal benefits, rehabilitation has not been prioritised in countries and is under-resourced. We present global, regional, and country data for the number of people who would benefit from rehabilitation at least once during the course of their disabling illness or injury.
METHODS
To estimate the need for rehabilitation, data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 were used to calculate the prevalence and years of life lived with disability (YLDs) of 25 diseases, impairments, or bespoke aggregations of sequelae that were selected as amenable to rehabilitation. All analyses were done at the country level and then aggregated to seven regions: World Bank high-income countries and the six WHO regions (ie, Africa, the Americas, Southeast Asia, Europe, Eastern Mediterranean, and Western Pacific).
FINDINGS
Globally, in 2019, 2·41 billion (95% uncertainty interval 2·34-2·50) individuals had conditions that would benefit from rehabilitation, contributing to 310 million [235-392] YLDs. This number had increased by 63% from 1990 to 2019. Regionally, the Western Pacific had the highest need of rehabilitation services (610 million people [588-636] and 83 million YLDs [62-106]). The disease area that contributed most to prevalence was musculoskeletal disorders (1·71 billion people [1·68-1·80]), with low back pain being the most prevalent condition in 134 of the 204 countries analysed.
INTERPRETATION
To our knowledge, this is the first study to produce a global estimate of the need for rehabilitation services and to show that at least one in every three people in the world needs rehabilitation at some point in the course of their illness or injury. This number counters the common view of rehabilitation as a service required by only few people. We argue that rehabilitation needs to be brought close to communities as an integral part of primary health care to reach more people in need.
FUNDING
Bill & Melinda Gates Foundation.
Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Disabled Persons; Female; Global Burden of Disease; Global Health; Humans; Male; Middle Aged; Musculoskeletal Diseases; Needs Assessment; Nervous System Diseases; Prevalence; Quality-Adjusted Life Years; Sensation Disorders; Sex Distribution; Young Adult
PubMed: 33275908
DOI: 10.1016/S0140-6736(20)32340-0 -
Multiple Sclerosis (Houndmills,... Oct 2020To provide clinicians who treat multiple sclerosis (MS) patients with evidence-based or expert opinion-based recommendations for promoting exercise and lifestyle...
OBJECTIVES
To provide clinicians who treat multiple sclerosis (MS) patients with evidence-based or expert opinion-based recommendations for promoting exercise and lifestyle physical activity across disability levels.
METHODS
The National MS Society ("Society") convened clinical and research experts in the fields of MS, exercise, rehabilitation, and physical activity to (1) reach consensus on optimal exercise and lifestyle physical activity recommendations for individuals with MS at disability levels 0-9.0 on the Expanded Disability Status Scale (EDSS) and (2) identify and address barriers/facilitators for participation.
RECOMMENDATIONS
Based on current evidence and expert opinion, the Society makes the following recommendations, endorsed by the Consortium of Multiple Sclerosis Centers:Healthcare providers should endorse and promote the benefits/safety of exercise and lifestyle physical activity for every person with MS.Early evaluation by a physical or occupational therapist or exercise or sport scientist, experienced in MS (hereafter referred to as "specialists"), is recommended to establish an individualized exercise and/or lifestyle physical activity plan.Taking into account comorbidities and symptom fluctuations, healthcare providers should encourage ⩾150 min/week of exercise and/or ⩾150 min/week of lifestyle physical activity.Progress toward these targets should be gradual, based on the person's abilities, preferences, and safety.If disability increases and exercise/physical activity becomes more challenging, referrals to specialists are essential to ensure safe and appropriate prescriptions.When physical mobility is very limited, exercise should be facilitated by a trained assistant.
Topics: Disabled Persons; Exercise; Exercise Therapy; Humans; Life Style; Multiple Sclerosis
PubMed: 32323606
DOI: 10.1177/1352458520915629 -
BMC Geriatrics Jul 2019The number of older people with unmet care and support needs is increasing substantially due to the challenges facing the formal and informal care system in the United... (Review)
Review
Understanding the care and support needs of older people: a scoping review and categorisation using the WHO international classification of functioning, disability and health framework (ICF).
BACKGROUND
The number of older people with unmet care and support needs is increasing substantially due to the challenges facing the formal and informal care system in the United Kingdom. Addressing these unmet needs is becoming one of the urgent public health priorities. In order to develop effective solutions to address some of these needs, it is important first to understand the care and support needs of older people.
METHODS
A scoping review was conducted, using the Arksey and O'Malley original and enhanced framework, to understand the care and support needs of older people, focusing on those living at home with chronic conditions in the UK. The search was conducted using five electronic data bases, grey literature and reference list checks. The WHO International Classification of Functioning, Disability and Health (ICF) framework was used to analyse and categorise the literature findings.
RESULTS
Forty studies were included in the final analysis- 32 from academic literature and 8 from grey literature. The review highlighted that older adults faced a range of physical, social and psychological challenges due to living with chronic conditions and required care and support in three main areas: 1) social activities and relationships; 2) psychological health; and 3) activities related to mobility, self-care and domestic life. The review also highlighted that many older people demonstrated a desire to cope with their illness and maintain independence, however, environmental factors interfered with these efforts including: 1) lack of professional advice on self-care strategies; 2) poor communication and coordination of services; and 3) lack of information on services such as care pathways. A gap in the knowledge was also identified about the care and support needs of two groups within the older population: 1) older workers; and 2) older carers.
CONCLUSIONS
The review highlighted that older people living with chronic conditions have unmet care needs related to their physical and psychological health, social life, as well as the environment in which they live and interact. Findings of this review also emphasized the importance of developing care models and support services based around the needs of older people.
Topics: Aged; Aged, 80 and over; Caregivers; Chronic Disease; Disabled Persons; Health Services Needs and Demand; Health Status; Humans; International Classification of Functioning, Disability and Health; Mental Health; United Kingdom; World Health Organization
PubMed: 31331279
DOI: 10.1186/s12877-019-1189-9 -
Journal of General Internal Medicine Jul 2019Patient-centered care for people with disability requires effective communication and compliance with the Americans with Disabilities Act (ADA).
BACKGROUND
Patient-centered care for people with disability requires effective communication and compliance with the Americans with Disabilities Act (ADA).
OBJECTIVE
To understand physicians' perspectives on communication experiences with people with disability.
DESIGN
Twenty semi-structured individual interviews. Interview recordings were transcribed verbatim for analysis.
SETTING
Massachusetts, October 2017-January 2018.
PARTICIPANTS
Twenty physicians ranging from 8 to 51 years in practice in primary care or 4 other specialties.
MEASUREMENTS
Commonly expressed themes around communication with people with disability.
RESULTS
Concerns coalesced around 4 broad categories: communication experiences with people who are deaf or hard of hearing, communication with people who are blind or have vision impairment, communication with people who have intellectual disability, and recommendations for improving communication. Although participants in this study reported various efforts to communicate effectively with patients with hearing or vision loss or intellectual disability, many gaps appear to remain, as well as instances where physicians' preferences run counter to patients' wishes and the ADA. Examples include physicians' preferences for remote, online sign language interpreters despite patients desiring in-person interpreters and suggesting that patients arrange for their own interpreters. Few educational materials are available in braille, and electronic medical records may not allow documents to be printed in large font for persons with low vision. Communicating with patients with intellectual disability raised particular concerns, with participants often preferring to interact with caregivers and minimal efforts to involve patients.
CONCLUSIONS
Effective communication is necessary for ensuring the quality of health care for people with disability, and it is legally required under the ADA. Our results suggest that important gaps may remain in ensuring effective communication, and some practicing physicians could benefit from formal training in effective methods for communicating with patients with disability.
Topics: Adult; Aged; Communication; Communication Barriers; Disabled Persons; Female; Humans; Male; Middle Aged; Patient-Centered Care; Physician-Patient Relations; Physicians
PubMed: 30887435
DOI: 10.1007/s11606-019-04911-0 -
Brazilian Journal of Physical Therapy 2021Beliefs about the body and pain play a powerful role in behavioural and emotional responses to musculoskeletal pain. What a person believes and how they respond to their... (Review)
Review
BACKGROUND
Beliefs about the body and pain play a powerful role in behavioural and emotional responses to musculoskeletal pain. What a person believes and how they respond to their musculoskeletal pain can influence how disabled they will be by pain. Importantly, beliefs are modifiable and are therefore considered an important target for the treatment of pain-related disability. Clinical guidelines recommend addressing unhelpful beliefs as the first line of treatment in all patients presenting with musculoskeletal pain. However, many clinicians hold unhelpful beliefs themselves; while others feel ill-equipped to explore and target the beliefs driving unhelpful responses to pain. As a result, clinicians may reinforce unhelpful beliefs, behaviours and resultant disability among the patients they treat.
METHODS
To assist clinicians, in Part 1 of this paper we discuss what beliefs are; how they are formed; the impact they can have on a person's behaviour, emotional responses and outcomes of musculoskeletal pain. In Part 2, we discuss how we can address beliefs in clinical practice. A clinical case is used to illustrate the critical role that beliefs can have on a person's journey from pain and disability to recovery.
CONCLUSIONS
We encourage clinicians to exercise self-reflection to explore their own beliefs and better understand their biases, which may influence their management of patients with musculoskeletal pain. We suggest actions that may benefit their practice, and we propose key principles to guide a process of behavioural change.
Topics: Disabled Persons; Humans; Musculoskeletal Pain; Pain Management
PubMed: 32616375
DOI: 10.1016/j.bjpt.2020.06.003 -
American Family Physician Feb 2021Sexual violence is a major public health and human rights issue affecting more than 40% of women in the United States during their lifetimes. Although men and women...
Sexual violence is a major public health and human rights issue affecting more than 40% of women in the United States during their lifetimes. Although men and women experience sexual assault, women are at greatest risk. Populations uniquely impacted by sexual assault include adolescents; lesbian, gay, bisexual, transgender, and queer people; and active-duty military service members. Health consequences of sexual assault include sexually transmitted infections, risk of unintended pregnancy, high rates of mental health conditions (e.g., posttraumatic stress disorder), and development of chronic medical conditions (e.g., chronic pelvic pain). Family physicians care for sexual assault survivors at the time of the assault and years after, and care should follow a survivor-centered and trauma-informed framework. Multiple organizations recommend screening all women for a history of sexual violence; however, the U.S. Preventive Services Task Force recommends only universal intimate partner violence screening in women of reproductive age. A validated tool, such as the Two-Question Screening Tool, can be implemented. Initial care should include treatment of physical injuries, prophylaxis for sexually transmitted infections, immunizations, and the sensitive management of psychological issues. Clinicians must comply with state and local requirements for the use of evidence-gathering kits. Many hospitals have developed collection protocols and employ certified Sexual Assault Nurse Examiners or Sexual Assault Forensic Examiners. Prevention of sexual violence requires a comprehensive approach to address individual, relational, community, and societal factors.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Curriculum; Disabled Persons; Education, Medical, Continuing; Female; Guidelines as Topic; Humans; Male; Middle Aged; Rape; Sex Offenses; United States; Young Adult
PubMed: 33507052
DOI: No ID Found -
Developmental Medicine and Child... May 2020
Topics: Disabled Persons; Empowerment; Humans; Power, Psychological
PubMed: 32249940
DOI: 10.1111/dmcn.14511 -
PloS One 2019To know the prevalence, associated factors and temporal trends of disabilities for basic and instrumental activities of daily living in older people in Spain from 2009...
AIMS
To know the prevalence, associated factors and temporal trends of disabilities for basic and instrumental activities of daily living in older people in Spain from 2009 to 2017.
BACKGROUND
Disability in older people is associated with health problems, increased health costs and low quality of life. There are no updated data in Spain with a representative sample about disability.
METHODS
Cross-sectional study with 25,465 non-institutionalized older people who participated in the European Health Survey in 2009 and 2014 and the National Health Survey in 2011/12 and 2017 in Spain. The prevalence rates of disability were evaluated using the Katz Scale and Lawton and Brody Scale. Logistic regression was used to determine if there was an association between basic and instrumental activities of daily living and sociodemographic characteristics.
RESULTS
More individuals had disability for instrumental activities of daily living (31.9%) than disability for basic activities of daily living (11.1%). The most predominant disability for instrumental activities of daily living was performing severe housework (34%). The prevalence of disabilities decreased from 2009 to 2017. In general, disability was associated with female gender, advanced age, lower education, restricted daily activity, being bedridden and higher pain levels.
CONCLUSION
There is a considerable prevalence of disabilities for basic and instrumental activities of daily living in older people in Spain. Although the disability prevalence has decreased slowly from 2009 to 2017, it continues to remain a health problem. Gender may influence the disabilities for basic and instrumental activities of daily living. Health policymakers should establish prevention strategies and effective interventions (e.g., physical exercise) for prevention and reduction of the disabilities for basic and instrumental activities of daily living, particularly in older females.
Topics: Activities of Daily Living; Aged; Aged, 80 and over; Cross-Sectional Studies; Disability Evaluation; Disabled Persons; Female; Geriatric Assessment; Health Surveys; Humans; Logistic Models; Male; Prevalence; Sex Factors; Socioeconomic Factors; Spain
PubMed: 31348797
DOI: 10.1371/journal.pone.0220157 -
Archives of Physical Medicine and... Mar 2021Recent research and the actions of the World Health Organization (WHO) have clarified the nature and value of rehabilitation as a key health strategy of the 21st...
Recent research and the actions of the World Health Organization (WHO) have clarified the nature and value of rehabilitation as a key health strategy of the 21st century. However, strengthening rehabilitation in national health systems around the world is a challenge, partly because there is not an evidence-based argument that rehabilitation is a good economic and social investment. This argument, in turn, depends on characterizing the current and potential beneficiaries of rehabilitation, namely the individuals who could benefit from rehabilitation services whether or not they currently receive these services. Although identifying current beneficiaries is essential for evaluating the current demand for rehabilitation in existing health systems, as well as for making the economic investment case for rehabilitation within national health systems, it is only by characterizing potential beneficiaries that we can identify unmet needs and the potential social effect of rehabilitation. The objective of this study is to take a preliminary step toward both tasks by offering an overview of intuitively plausible approaches to characterizing beneficiaries of rehabilitation and to highlight limitations and challenges with each approach. We rely on the WHO's definition of rehabilitation, particularly the aim of rehabilitation to "optimize functioning and reduce disability," as our starting point.
Topics: Disabled Persons; Global Health; Humans; Needs Assessment; Rehabilitation
PubMed: 33239179
DOI: 10.1016/j.apmr.2020.09.392 -
The Lancet. Global Health Aug 2021
Topics: COVID-19; Data Collection; Disabled Persons; Global Health; Humans
PubMed: 34297946
DOI: 10.1016/S2214-109X(21)00312-0