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Waterworth CJ, Smith F, Kiefel-Johnson F, Pryor W, Marella M. Integration of rehabilitation services in primary, secondary, and tertiary levels of health care systems in low- and middle-income countries: a scoping review. Disabil Rehabil 2024:1-12. [PMID: 38376099 DOI: 10.1080/09638288.2024.2317422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 02/06/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Integration is a concept that seeks to strengthen the delivery of services to ensure people receive a continuum of care across the health system. We conducted a scoping review to explore how rehabilitation services have been integrated into health systems in low- and middle- income countries (LMICs). MATERIALS AND METHODS We conducted a scoping review using Valentijn's Rainbow Model of Integrated Care (RMIC) as an organising framework. The key enablers of integration of rehabilitation were extracted, charted and summarised according to the RMIC framework. RESULTS Of 4667 articles identified, 44 met inclusion criteria. Most studies focused on rehabilitation within secondary and tertiary level facilities, and described service models incorporating clinical, professional and functional integration characteristics. The geographical and clinical scope of rehabilitation models that demonstrate elements of integration from LMICs is limited. CONCLUSION The key enablers identified highlight the important role of responsive multidisciplinary care plans, and interdisciplinary guidelines, protocols and interprofessional education to support an integrated rehabilitation service model in LMICs.
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Affiliation(s)
- Christopher James Waterworth
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
- Department of Audiology and Speech Pathology, University of Melbourne, Melbourne, VIC, Australia
| | - Fleur Smith
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Felix Kiefel-Johnson
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Wesley Pryor
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Manjula Marella
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
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Diaz MM, Bailey M, Garcia B, Aguilar XR, Sanchez DC. Mental health impact of the COVID-19 pandemic on patients with neurodegenerative diseases and perceived family caregiver burden in Lima, Peru. Brain Behav 2024; 14:e3361. [PMID: 38236201 PMCID: PMC10761328 DOI: 10.1002/brb3.3361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/20/2023] [Accepted: 11/25/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Neurodegenerative diseases lead to difficulties with functional activities. In Peru, most caregivers are family members. Little is known about the COVID-19 pandemic's effect on caregivers in Peru. METHODS This was a cross-sectional, prospective study of family caregivers of dependent patients with dementia or Parkinson's Disease in Lima, Peru. A caregiver burden and mental health questionnaire was administered to the caregiver. RESULTS We enrolled 48 caregivers (65% females, mean ± SD age 49.0 ± 12.3 years); 70% of patients had dementia. Nearly 40% of caregivers reported having full-time jobs, and 82% felt overwhelmed with almost 75% dedicating more time to caregiving during the pandemic. Caregivers perceived patients felt lonelier (52%), had an increase in hallucinations (50%), or forgetfulness (71%) compared to pre-pandemic. CONCLUSIONS Our study highlights that perceived caregiver burden and patient behavioral symptoms may have been exacerbated during the pandemic. In countries such as Peru, more caregiving resources and interventions are needed.
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Affiliation(s)
- Monica M. Diaz
- Department of NeurologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Maisie Bailey
- School of MedicineOregon Health Sciences UniversityPortlandOregonUSA
| | - Bettsie Garcia
- Department of NeurologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Ximena R. Aguilar
- Department of Neurodegenerative DiseasesInstituto Nacional de Ciencias Neurologicas PeruLimaPeru
| | - Danilo Coronel Sanchez
- Department of Neurodegenerative DiseasesInstituto Nacional de Ciencias Neurologicas PeruLimaPeru
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Almubaslat F, Sanchez-Boluarte SS, Diaz MM. A review of neurological health disparities in Peru. Front Public Health 2023; 11:1210238. [PMID: 37744515 PMCID: PMC10513391 DOI: 10.3389/fpubh.2023.1210238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
Peru is a historically unique and culturally diverse Latin American country. As a low-to-middle-income country (LMIC), Peru faces health implications from the spread of communicable diseases as well as a growing rate of noncommunicable diseases, both of which have been worsened by the recent COVID-19 pandemic's impact on the national health system. Over the past two decades, the country has aimed to improve health access for its population through various efforts described in this review. Despite this, there are notable neurological health disparities that exist today. This narrative review investigates such disparities through the leading neurological contributors to the national burden of disease in the country, including migraine headaches, cerebrovascular disease, and dementia. Public health disparities that contribute to other major neurological diseases in the country, including epilepsy, neurocysticercosis, Chagas disease, multiple sclerosis, traumatic brain injury, traumatic and non-traumatic spinal cord injuries are also investigated. We also explore potential solutions for overcoming the various neurological health disparities covered in this review that may be applied through public policies, as well as in similar LMICs in Latin America. By overcoming such disparities, the country may be able to successfully address the major contributors of neurological disease burden and create a healthcare environment that can sustainably and equitably improve health outcomes for Peruvian people.
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Affiliation(s)
- Faris Almubaslat
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Monica M. Diaz
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Cacho RDO, Moro CHC, Bazan R, Guarda SNFD, Pinto EB, Andrade SMMDS, Valler L, Almeida KJ, Ribeiro TS, Jucá RVBDM, Minelli C, Piemonte MEP, Paschoal EHA, Pedatella MTA, Pontes-Neto OM, Fontana AP, Pagnussat ADS, Conforto AB. Access to rehabilitation after stroke in Brazil (AReA study): multicenter study protocol. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:1067-1074. [PMID: 36535291 PMCID: PMC9770079 DOI: 10.1055/s-0042-1758558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Most of the Brazilian population relies on public healthcare and stroke is a major cause of disability in this country of continental dimensions. There is limited information about access to rehabilitation after stroke in Brazil. OBJECTIVE To provide comprehensive information about Access to Rehabilitation After discharge from public hospitals in Brazil (AReA study), up to 6 months after stroke. METHODS The present study intends to collect information from 17 public health centers in 16 Brazilian cities in the 5 macroregions of the country. Each center will include 36 participants (n = 612). The inclusion criteria are: age ≥ 18 years old; ischemic or hemorrhagic stroke, from 6 months to 1 year prior to the interview; admission to a public hospital in the acute phase after stroke; any neurological impairment poststroke; patient or caregiver able to provide informed consent and answer the survey. Patients can only be recruited in public neurology or internal medicine outpatient clinics. Outcomes will be assessed by a standard questionnaire about rehabilitation referrals, the rehabilitation program (current status, duration in months, number of sessions per week) and instructions received. In addition, patients will be asked about preferences for locations of rehabilitation (hospitals, clinics, or at home). TRIAL STATUS The study is ongoing. Recruitment started on January 31st, 2020 and is planned to continue until June 2022. CONCLUSION The AReA study will fill a gap in knowledge about access to stroke rehabilitation in the public health system in different Brazilian regions.
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Affiliation(s)
- Roberta de Oliveira Cacho
- Universidade Federal do Rio Grande do Norte, Faculdade de Ciências da Saúde do Trairi, Santa Cruz RN, Brazil.,Address for correspondence Roberta de Oliveira Cacho
| | | | - Rodrigo Bazan
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, São Paulo SP, Brazil.
| | | | - Elen Beatriz Pinto
- Escola Bahiana de Medicina e Saúde Pública, Fundação para o Desenvolvimento das Ciências, Salvador BA, Brazil.
| | | | - Lenise Valler
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Campinas SP, Brazil.
| | - Kelson James Almeida
- Universidade Federal do Piauí, Centro Universitário UniFacid, Departamento de Medicina Especializada em Neurologia, Teresina PI, Brazil.
| | - Tatiana Souza Ribeiro
- Universidade Federal do Rio Grande do Norte, Departamento de Fisioterapia, Natal RN, Brazil.
| | | | - Cesar Minelli
- Hospital Carlos Fernando Malzoni, Instituto “Você sem AVC”, Matão SP, Brazil.,Universidade de São Paulo, Departamento de Neurociências e Ciências Comportamentais, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto SP, Brazil.
| | - Maria Elisa Pimentel Piemonte
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil.
| | | | | | | | - Ana Paula Fontana
- Universidade Federal do Rio de Janeiro, Faculdade de Fisioterapia, Laboratório Pesquisa em Recuperação Funcional Após AVC, Rio de Janeiro RJ, Brazil.
| | - Aline de Souza Pagnussat
- Universidade Federal de Ciências da Saúde de Porto Alegre, Departamento de Fisioterapia, Porto Alegre RS, Brazil.
| | - Adriana Bastos Conforto
- Universidade de São Paulo, Hospital de Clínicas, Divisão de Neurologia Clínica, São Paulo SP, Brazil.,Hospital Israelita Albert Einstein, São Paulo SP, Brazil.
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Soni KD, Bansal V, Arora H, Verma S, Wärnberg MG, Roy N. The State of Global Trauma and Acute Care Surgery/Surgical Critical Care. Crit Care Clin 2022; 38:695-706. [PMID: 36162905 DOI: 10.1016/j.ccc.2022.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Trauma is a leading cause of morbidity and mortality globally, with a significant burden attributable to the low- and middle-income countries (LMICs), where more than 90% of injury-related deaths occur. Road injuries contribute largely to the economic burden from trauma and are prevalent among adolescents and young adults. Trauma systems vary widely across the world in their capacity of providing basic and critical care to injured patients, with delays in treatment being present at multiple levels at LMICs. Strengthening existing systems by providing cost-effective and efficient solutions can help mitigate the injury burden in LMICs.
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Affiliation(s)
- Kapil Dev Soni
- Critical & Intensive Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, Ring Road, Raj Nagar, Safdarjung Enclave, New Delhi, Delhi 110029, India
| | - Varun Bansal
- Department of General Surgery, 2nd Floor Registration Building, Seth G.S.M.C. and K.E.M. Hospital, Parel, Mumbai 400012, India
| | - Harshit Arora
- Department of Surgery, Punjab Institute of Medical Sciences, Gadha Road, Jalandhar, Punjab 144006, India
| | - Sukriti Verma
- Department of Blood Bank, Guru Teg Bahadur Hospital, Tahirpur Rd, GTB Enclave, Dilshad Garden, New Delhi, Delhi 110095, India; WHO Collaborating Center for Research on Surgical Care Delivery in LMICs, Department of Surgery, BARC Hospital, Anushaktinagar, Mumbai 400094, India
| | - Martin Gerdin Wärnberg
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18, 171 65 Solna, Stockholm 171 65, Sweden; Function Perioperative Medicine and Intensive Care, Karolinska University Hospital Solna, SE - 171 76, Stockholm, Sweden
| | - Nobhojit Roy
- WHO Collaborating Center for Research on Surgical Care Delivery in LMICs, Department of Surgery, BARC Hospital, Anushaktinagar, Mumbai 400094, India; The George Institute of Global Health India, F-BLOCK, 311-312, Third Floor, Jasola Vihar, New Delhi, Delhi 110025, India.
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Tovani-Palone MR, Mejia CR, Quispe-Sancho A, Chambi-Macedo KL, Laurel-Vargas V, Huamani-Merma E, Cuzcano-Gonzales KV, Huaita-Rocha MA, Mendoza-Guillen L, Sanchez-Choquepata AD, Fuentes-Casani J, Bandeira A. Depression, Anxiety, and Stress in Health Professionals Working During the COVID-19 Pandemic in Peru: An Analytical Cross-Sectional Study. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2021. [DOI: 10.29333/ejgm/11210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Donnelley CA, Shirley C, von Kaeppler EP, Hetherington A, Albright PD, Morshed S, Shearer DW. Cost Analyses of Prosthetic Devices: A Systematic Review. Arch Phys Med Rehabil 2021; 102:1404-1415.e2. [PMID: 33711275 DOI: 10.1016/j.apmr.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/22/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To synthesize extant literature on the cost-effectiveness of prosthetic interventions and explore applicability to low- and middle-income country (LMIC) settings. DATA SOURCES A systematic literature review using subject headings including "prosthetics," "amputation," and "cost analysis" was performed with PubMed, Embase, and Web of Science search engines, yielding 1194 articles. An additional 22 articles were identified via backward citation searching for 1144 total after duplicate removal. The search was last run in May of 2019. STUDY SELECTION Studies were included if they conducted an economic analysis of an upper or lower extremity prosthetic device. Studies were excluded if (1) full text was unavailable in English; (2) study was a systematic review or meta-analysis; or (3) study did not have a prosthetic comparison group. Using DistillerSR software, 2 authors independently conducted title and abstract screening. One author conducted full-text screening. The proportion of initially identified studies that met final inclusion criteria was 1% (12 of 1144). DATA EXTRACTION Data were dually extracted by 2 authors and reviewed by 3 additional authors. DATA SYNTHESIS All included studies (N=12) examined lower extremity amputations comparing advanced technology. No studies were conducted in LMICs. Comparable data between studies demonstrated (1) the cost-effectiveness of microprocessor- over nonmicroprocessor-controlled knees for transfemoral amputation in high-income settings; (2) equivocal findings regarding osseointegrated vs socket-suspended prostheses; and (3) increased cost for ICEX and modular socket systems over patellar tendon-bearing socket systems with no functional improvement. CONCLUSIONS There are few prosthetic cost analyses in the literature. Additional analyses are needed to determine the direct and indirect costs associated with prosthetic acquisition, fitting, and maintenance; the costs of amputee rehabilitation; and long-term economic and quality-of-life benefits. Such studies may guide future prosthetic and rehabilitative care, especially in resource-austere settings where prosthetic needs are greatest.
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Affiliation(s)
- Claire A Donnelley
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, San Francisco, CA
| | - Corin Shirley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA
| | - Ericka P von Kaeppler
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, San Francisco, CA
| | - Alexander Hetherington
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA
| | | | - Saam Morshed
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, San Francisco, CA
| | - David W Shearer
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, San Francisco, CA.
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Anh NTK, Yen LM, Nguyen NT, Nhat PTH, Thuy TTD, Phong NT, Tuyen PT, Yen NH, Chambers M, Hao NV, Rollinson T, Denehy L, Thwaites CL. Feasibility of establishing a rehabilitation programme in a Vietnamese intensive care unit. PLoS One 2021; 16:e0247406. [PMID: 33657158 PMCID: PMC7928504 DOI: 10.1371/journal.pone.0247406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/08/2021] [Indexed: 11/18/2022] Open
Abstract
Increasing numbers of people are surviving critical illness throughout the world, but survivorship is associated with long-term disability. In high-income settings physical rehabilitation is commonly employed to counter this and improve outcomes. These utilize highly-trained multidisciplinary teams and are unavailable and unaffordable in most low and middle income countries (LMICs). We aimed to design a sustainable intensive care unit (ICU) rehabilitation program and to evaluate its feasibility in a LMIC setting. In this project patients, care-givers and experts co-designed an innovative rehabilitation programme that can be delivered by non-expert ICU staff and family care-givers in a LMIC. We implemented this programme in adult patient with patients with tetanus at the Hospital for Tropical Diseases, Ho Chi Minh City over a 5-month period, evaluating the programme's acceptability, enablers and barriers. A 6-phase programme was designed, supported by written and video material. The programme was piloted in total of 30 patients. Rehabilitation was commenced a median 14 (inter quartile range (IQR) 10-18) days after admission. Each patient received a median of 25.5 (IQR 22.8-34.8) rehabilitation sessions out of a median 27 (22.8-35) intended (prescribed) sessions. There were no associated adverse events. Patients and staff found rehabilitation to be beneficial, enhanced relationships between carers, patients and staff and was deemed to be a positive step towards recovery and return to work. The main barrier was staff time. The programme was feasible for patients with tetanus and viewed positively by staff and participants. Staff time was identified as the major barrier to ongoing implementation.
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Affiliation(s)
| | - Lam Minh Yen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | | | | | - Pham Thi Tuyen
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Hoang Yen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Mary Chambers
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | | | | - C. Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- * E-mail:
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Crossing the Global Quality Chasm in Health Care: Where Does Rehabilitation Stand? Arch Phys Med Rehabil 2019; 100:2215-2217. [DOI: 10.1016/j.apmr.2019.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 07/18/2019] [Accepted: 07/20/2019] [Indexed: 11/20/2022]
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