Global Need for Physical Rehabilitation: Systematic Analysis from the Global Burden of Disease Study 2017

Abstract

Background: To inform global health policies and resources planning, this paper analyzes evolving trends in physical rehabilitation needs, using data on Years Lived with Disability (YLDs) from the Global Burden of Disease Study (GBD) 2017. Methods: Secondary analysis of how YLDs from conditions likely benefiting from physical rehabilitation have evolved from 1990 to 2017, for the world and across countries of varying income levels. Linear regression analyses were used. Results: A 66.2% growth was found in estimated YLD Counts germane to physical rehabilitation: a significant and linear growth of more than 5.1 billion YLDs per year (99% CI: 4.8–5.4; r2 = 0.99). Low-income countries more than doubled (111.5% growth) their YLD Counts likely benefiting from physical rehabilitation since 1990. YLD Rates per 100,000 people and the percentage of YLDs likley benefiting from physical rehabilitation also grew significantly over time, across locations (all p > 0.05). Finally, only in high-income countries did Age-standardized YLD Rates significantly decrease (p < 0.01; r2 = 0.86). Conclusions: Physical rehabilitation needs have been growing significantly in absolute, per-capita and in percentage of total YLDs. This growth was found globally and across countries of varying income level. In absolute terms, growths were higher in lower income countries, wherein rehabilitation is under-resourced, thereby highlighting important unmet needs.

Development of the Rehabilitation Health Policy, Systems, and Services Research Field: Quantitative Analyses of Publications over Time (1990–2017) and across Country Type

“…In other words, we have found that the amount of Rehabilitation HPSSR is a disproportionate to the global population's needs for such services. All accounted for, we suggest that there is a urgent need to address the collective negligence and limited development of rehabilitation resources within and across many countries [2,6,8,9], the gaps in quality, access, and value of rehabilitation care worldwide [5,6,8,9,14], and the growing unmet needs for rehabilitation across countries of all income levels [1,6].…”

“…This diverges, for example, from the overall health policy and systems research, which is close to a 50-50% distribution between HICs and LMICs [21], with publications relevant to LMICs being those increasing at the highest rates [40]. The seminal World Report on Disability [66] estimated that 80% of people with disabilities live in LMICs, a recent analyses of data from the Global Burden of Disease 2017 found that LMICs account for 77% of the physical rehabilitation needs [1], while several reports point towards large unmet rehabilitation needs in LMICs [5,6,8,9]. While we found a significant growing trend in the portion of the country-specific Rehabilitation HPSSR publications that were focused on LMICs(up to 13% in 2017),a still higher preponderance of rehabilitation HPSSR is likely needed, especially in LMICs; transformational rather than incremental improvements would be required to address this gap.…”

“…The growth over time has been significant and relatively linear, i.e., constant, over the 28-year period; nonetheless, rehabilitation represents a very small portion of all HPSSR. This may be concerning given the current high levels of physical rehabilitation needs worldwide (e.g., in 2017, 40% of the world's non-fatal health loss came from conditions amenable to physical rehabilitation [1]), the significant growth in those needs observed across country and condition types [1,61], the evidence for large gaps in the physical rehabilitation supply [6,29], and the growing evidence on the individual, economic, and broader societal benefits associated to the delivery of appropriate physical rehabilitation services [2,[62][63][64][65]. In other words, we have found that the amount of Rehabilitation HPSSR is a disproportionate to the global population's needs for such services.…”

“…Hence, some forms of rehabilitation were excluded, such as the rehabilitation of mental health conditions (psychiatric rehabilitation), substance abuse, people with sensory impairments per se (e.g., correction of hearing impairment), and people with oral health conditions. However, for example, the rehabilitation of cognitive, communicative, and neuro-behavioral impairments as a result of or associated to physical impairments were included in the scope of rehabilitation covered [1,37,53]. With that field restriction, and based on existing conceptual works or definitions of rehabilitation [1,[53][54][55][56][57] as well as published search filters [35][36][37], we also approached the MeSH database to identify rehabilitation-related MeSH terms and any to be excluded with the Bolean operator "NOT"; for example, "psychiatric rehabilitation" [MeSH] is within the upper-level "rehabilitation" [MeSH], hence needed to be actively excluded.…”

“…Rehabilitation services are increasingly needed around the globe, following the global ageing population and the increased rates of chronic conditions and disabilities [1,2]. However, health systems worldwide are often under-resourced and ill-prepared to efficiently meet the rehabilitation needs of the population [3][4][5][6][7][8][9].…”