Emerging Areas of Stroke Rehabilitation Research in Low- and Middle-Income Countries

Bettger, Janet Prvu; Liu, Chelsea; Gandhi, Dorcas B.C.; Sylaja, PN; Jayaram, Nitha; Pandian, Jeyaraj Durai

doi:10.1161/strokeaha.119.023565

Cited by 29 publications

(40 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Much of the prior research on rehabilitation in LMIC has focused on highlighting or quantifying the lack of rehabilitation services, especially in rural and economically poorer regions, and this impact on poorer health outcomes [13][14][15][16][17][18][19]. Even with the Global Stroke Services Guideline and Action Plan providing recommendations for minimal, essential, and advanced levels of service provision [20], our study indicates some challenges to achieving this consistent with the challenges identified by others for implementing rehabilitation services in LMIC settings.…”

Section: Discussionsupporting

confidence: 53%

What would ‘upscaling’ involve? A qualitative study of international variation in stroke rehabilitation

Watkins

Levack

Rathore

et al. 2021

BMC Health Serv Res

View full text Add to dashboard Cite

Background Demand for stroke rehabilitation is expected to grow dramatically; with the estimated prevalence of stroke survivors rising to 70 million worldwide by 2030. The World Health Organization’s (WHO) report - Rehabilitation 2030: A call for action – has introduced the objective of ‘upscaling’ rehabilitation globally to meet demand. This research explored what upscaling stroke rehabilitation might mean for health professionals from countries at different stages of economic development. Methods Qualitative descriptive study design using semi-structured interviews was employed. Purposively sampled, clinical leaders in stroke rehabilitation were recruited for interviews from low through to high-income countries. Results Twelve rehabilitation professionals (medicine, physical therapy, occupational therapy, and speech and language therapy) from high (United States of America, Germany, United Kingdom, United Arab Emirates, New Zealand), upper-middle (Colombia and Turkey), lower-middle (Vietnam, Pakistan, Ghana), and low-income countries (Nepal and Sierra Leone) were interviewed. Upscaling was seen as a necessity. Successful scaling up will require initiatives addressing: political governance and managerial leadership, increasing knowledge and awareness of the value of rehabilitation, financial support, workforce developments, physical space and infrastructure, and the development of community services and reintegration. Conclusion Although there have been many gains within the development of stroke rehabilitation internationally, further investment is required to ensure that this patient population group continues to receive the best quality services. For the WHO to be successful in implementing their objective to upscale rehabilitation, specific attention will need to be paid to political, professional, economic, and sociocultural issues at global and local levels.

show abstract

Section: Discussionsupporting

confidence: 53%

What would ‘upscaling’ involve? A qualitative study of international variation in stroke rehabilitation

Watkins

Levack

Rathore

et al. 2021

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…As more stakeholders recognize the value of telerehabilitation, catalyzed by the COVID-19 pandemic, more efforts can be made to address the various challenges besetting the emergence of telerehabilitation in the country. Researches on telerehabilitation and policy changes through Delphi method can help us respond better to the World Health Organization's Rehabilitation 2030 Call to Action to improve access to rehabilitation services (10,42,57). A lot of work has yet to be done to address the human, organizational, and technical challenges to telerehabilitation, but we can be guided by existing local and international evidences, along with experts in telehealth and medical informatics, to avoid costly and time-consuming trial-and-error attempts.…”

Section: Discussionmentioning

confidence: 99%

Challenges to the Emergence of Telerehabilitation in a Developing Country: A Systematic Review

et al. 2020

View full text Add to dashboard Cite

Background: Despite being known abroad as a viable alternative to face-to-face consultation and therapy, telerehabilitation has not fully emerged in developing countries like the Philippines. In the midst of the coronavirus disease 2019 (COVID-19) pandemic, wherein social distancing disrupted the in-clinic delivery of rehabilitation services, Filipinos attempted to explore telerehabilitation. However, several hindrances were observed especially during the pre-implementation phase of telerehabilitation, necessitating a review of existing local evidences. Objective: We aimed to determine the challenges faced by telerehabilitation in the Philippines. Method: We searched until March 2020 through PubMed, Scopus, Embase, Cochrane Library, and HeRDIN for telerehabilitation-related publications wherein Filipinos were involved as investigator or population. Because of the hypothesized low number of scientific outputs on telerehabilitation locally, we performed handsearching through gray literature and included relevant papers from different rehabilitation-related professional organizations in the Philippines. We analyzed the papers and extracted the human, organizational, and technical challenges to telerehabilitation or telehealth in general. Results: We analyzed 21 published and 4 unpublished papers, which were mostly reviews (8), feasibility studies (6), or case reports/series (4). Twelve out of 25 studies engaged patients and physicians in remote teleconsultation, teletherapy, telementoring, or telemonitoring. Patients sought telemedicine or telerehabilitation for general medical conditions (in 3 studies), chronic diseases (2), mental health issues (2), orthopedic problems (2), neurologic conditions (1), communication disorders (1), and cardiac conditions (1). Outcomes in aforementioned studies mostly included telehealth acceptance, facilitators, barriers, and satisfaction. Other studies were related to telehealth governance, legalities, and ethical issues. We identified 18 human, 17 organizational, and 18 technical unique challenges related to telerehabilitation in the Philippines. The most common challenges were slow internet speed (in 10 studies), legal concerns (9), and skepticism (9). Leochico et al. Telerehabilitation Challenges in Developing Country Conclusion: There is paucity of data on telerehabilitation in the Philippines. Local efforts can focus on exploring or addressing the most pressing human, organizational, and technical challenges to the emergence of telerehabilitation in the country.

show abstract

“…LMICs face a much greater challenge in setting up stroke units due to lack of specialists, facilities, and other system-level barriers (Bernhardt, Urimubenshi, Gandhi, & Eng, 2020;Bettger et al, 2019;Yan et al, 2016), resulting in limited availability of effective rehabilitation services (Bettger et al, 2019;Gimigliano & Negrini, 2017;World Health Organisation, 2019;Yan et al, 2016). The cost of travelling to rehabilitation facilities makes the service even more burdensome for people with stroke and their families.…”

Section: Introductionmentioning

confidence: 99%

“…CBIs are used by the government, health institutions and professionals, case managers or community workers (Bettger et al, 2019;Iemmi et al, 2015;Johnson et al, 2020;Mannan et al, 2012;Ryan et al, 2006). When community workers are involved, they usually undergo training prior to delivering the interventions (Jansen-van Vuuren & Aldersey, 2019;Mannan et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

“…Majority of these studies on CBI are also of poor rigour and quality, thereby making the claims about the effectiveness of CBI delivered in LMICs inconclusive (Bowers et al, 2015;Iemmi et al, 2015). The lack of randomised controlled trials (RCTs) suggests the limited capacity of LMICs to conduct healthcare-oriented research (Bowers et al, 2015;Iemmi et al, 2015) possibly due to lack of interest of researchers and universities in such studies (Feng et al, 2013).The costs and training associated with conducting research and the lack of funding could have fuelled this lack of interest, or there might be some other independent reason (Bettger et al, 2019;Bowers et al, 2015;Pandian, Liu, Gandhi, & Lindley, 2017). This necessitates serious attention because CBI is provided as a rehabilitation service within the CBR framework, and the number of people with stroke who will need rehabilitation is expected to increase (Feigin et al, 2017;Magwood et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Effectiveness of Community-Based Interventions in Improving Activities of Daily Living and Quality of Life Outcomes in Persons Living with Stroke: a Systematic Review

Tosoc¹,

Lazaro²

2022

DCID

View full text Add to dashboard Cite

Purpose: Despite the growth of literature regarding community-based interventions (CBI) in low-to middle-income and high-income countries, its effectiveness in improving outcomes related to activities of daily living (ADL) and quality of life (QOL) in people with stroke is inconclusive. This systematic review compared the effectiveness of community-based interventions with the usual or hospital-based treatments in improving ADL and QOL outcomes in this population.Method: Four databases were systematically searched from inception until December 31, 2020, for relevant experimental studies from high-income and low-to middle-income countries that compared CBI with the usual/hospital rehabilitation on outcomes related to ADLs and QOL in clients with stroke. Results: All the 10 experimental studies that were included came from highincome countries (Italy, United Kingdom, South Korea, Canada, and Australia), involving 1575 participants (806 males, 656 females, 113 not classified) with age range from 22-103 years. Seven articles measured ADL performance, and 10 measured QOL. Results indicated that CBI generally demonstrates improvement in ADL and QOL values similar to usual or hospital-based care. There was wide variability in the interventions described and the outcome measures used for both groups. Risk of bias assessment revealed issues with randomisation, blinding and follow-up. Stroke-specific baseline characteristics such as length of time since diagnosis and laterality varied considerably in all of the studies.

show abstract

Emerging Areas of Stroke Rehabilitation Research in Low- and Middle-Income Countries

Cited by 29 publications

References 36 publications

What would ‘upscaling’ involve? A qualitative study of international variation in stroke rehabilitation

What would ‘upscaling’ involve? A qualitative study of international variation in stroke rehabilitation

Challenges to the Emergence of Telerehabilitation in a Developing Country: A Systematic Review

The Effectiveness of Community-Based Interventions in Improving Activities of Daily Living and Quality of Life Outcomes in Persons Living with Stroke: a Systematic Review

Contact Info

Product

Resources

About