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Htwe O, Yuliawiratman BS, Tannor AY, Nor Asikin MZ, Soh E, DE Groote W, Naicker MS, Naicker AS. Barriers and facilitators for increased accessibility to quality rehabilitation services in low- and middle- income countries: a systematic review. Eur J Phys Rehabil Med 2024; 60:514-522. [PMID: 38551518 DOI: 10.23736/s1973-9087.24.08154-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
INTRODUCTION With an increasing number of people experiencing limitations in functioning during their life course, the need for comprehensive rehabilitation services is high. In 2017, the WHO Rehabilitation 2030 initiative noted that the need for the establishment and expansion of rehabilitation services is paramount in order to obtain well-being for the population and to ensure equal access to quality healthcare for all. The organization of rehabilitation services is however facing challenges especially in low-and middle-income countries with a very small proportion of people who require rehabilitation actually getting them. Various surveys conducted in low-and -middle income countries have revealed existing gaps between the need for rehabilitation services and the actual receipt of these services. This systematic review aimed to determine the barriers and facilitators for increasing accessibility to rehabilitation services in low- and middle-income countries. Recommendations for strengthening rehabilitation service organization are presented based on the available retrieved data. EVIDENCE ACQUISITION In this systematic review, an electronic search through three primary databases, including Medline (PubMed), Scopus and Web of Science (WOS) was conducted to identify original studies reporting on barriers and facilitators for rehabilitation service organization in low-and middle-income countries. Date of search: 25th April 2021 (PubMed), 3rd May 2021 (Scopus and Web of Science). All studies including barriers or/and facilitators for rehabilitation services in low- and middle income countries which were written in English were included in the review. The articles written in other languages and grey literature, were excluded from this review. EVIDENCE SYNTHESIS Total of 42 articles were included from year 1989 to 2021. Numerous barriers were identified that related to education, resources, leadership, policy, technology and advanced treatment, community-based rehabilitation (CBR), social support, cultural influences, political issues, registries and standards of care. National health insurance including rehabilitation and funding from government and NGOs are some of the facilitators to strengthen rehabilitation service organization. Availability of CBR programs, academic rehabilitation training programs for allied health professionals, collaboration between Ministry of Heath (MOH) and Non-governmental Organizations (NGOs) on telerehabilitation services are amongst other facilitators. CONCLUSIONS Recommendations for improving and expanding rehabilitation service organization include funding, training, education, and sharing of resources.
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Affiliation(s)
- Ohnmar Htwe
- Rehabilitation Medicine Unit, Department of Orthopedics and Traumatology, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia -
| | | | - Abena Y Tannor
- Department of Health Promotion and Disability, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Muhamad Z Nor Asikin
- Department of Orthopedics and Traumatology, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Elaine Soh
- Department of Orthopedics and Traumatology, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Wouter DE Groote
- Department of Rehabilitation Medicine, AZ Rivierenland, Bornem, Belgium
| | | | - Amaramalar S Naicker
- Rehabilitation Medicine Unit, Department of Orthopedics and Traumatology, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Ramstrand N, Sterner A, Palmér L. Lower limb prosthesis users' perceptions of everyday life-A phenomenographic study. Prosthet Orthot Int 2024; 48:115-121. [PMID: 37318282 DOI: 10.1097/pxr.0000000000000246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/23/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION A lack of understanding of personal experiences related to limb amputation and prosthetic use limits the extent to which clinicians involved in rehabilitation can support and advise their clients in a person-centered consultation. The objective of this qualitative study was to explore the personal experience of daily life as a lower limb prosthesis user. METHODS Fifteen lower limb prosthesis users participated in individual semistructured interviews. Transcripts were analyzed using a phenomenographic approach. RESULTS The extent to which prosthesis users were able to adjust to their impairment and move on with their life was influenced by social interactions with other prosthesis users, access to relevant information about prosthetic solutions that may benefit them, and finding a balance between desired activities and their physical and/or cognitive capacity. CONCLUSIONS After a period of existential adjustment, prosthesis users described themselves as living active, fulfilling lives. This was facilitated to a large extent by social interactions with other prosthesis users and access to information they perceived as relevant. Social media plays a particularly important role in establishing connections with other prosthesis users and is perceived as a useful source of information.
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Affiliation(s)
- Nerrolyn Ramstrand
- Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Anders Sterner
- Department of Caring Science, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Lina Palmér
- Department of Caring Science, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Nuri RP, Xu X, Aldersey HM. Users' satisfaction and experiences in using assistive devices distributed by a rehabilitation centre in Bangladesh: a cross-sectional study. Disabil Rehabil Assist Technol 2024; 19:868-877. [PMID: 36215415 DOI: 10.1080/17483107.2022.2129849] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 09/18/2022] [Accepted: 09/22/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE This study aimed to understand Bangladeshi users' satisfaction with their assistive devices, including (a) device characteristics, e.g., size, weight, safety, ease of use, comfort, and effectiveness, and (b) availability of parts and repair services. We also described how frequently individuals with disabilities living in the community used assistive devices in their daily activities and how the use of assistive devices promoted individuals' wellbeing. METHOD We conducted a cross-sectional survey with assistive device users or their guardians (if under 18) in Bangladesh about their experience and satisfaction with their assistive device 6 months after receiving it. The research team developed a survey questionnaire consisting of both closed and open-ended questions. All data were collected via telephone interviews. We employed descriptive statistics to analyse quantitative data and inductive analysis for the qualitative data. RESULTS We found that out of the 376 participants, nearly 95% used assistive devices on a regular basis, and their satisfaction with the devices was high. Participants reported that assistive devices improved mobility, independence, and wellbeing of persons with disabilities. A few participants (6.4%) reported that their devices were damaged. Some participants identified concerns with their assistive devices, including (i) inappropriate size of ankle-foot orthoses, manual self-propelled wheelchairs, and prostheses, (ii) back slabs (a type of brace) being too short, and (iii) walking frames being too large. Several participants noted pain and discomfort when they used their assistive device. Additionally, some participants stated that environmental factors (e.g., muddy roads) contributed to the disrepair of their assistive devices. Finally, participants recounted that repair services were limited in rural areas of Bangladesh. CONCLUSION These findings indicate that the provision of assistive devices requires accommodating individuals' needs and ensuring appropriate environments in which to function. The results support the need for follow-up services after distributing assistive devices. Further research could explore the impact of assistive devices on the family quality of life of persons with disabilities.IMPLICATIONS FOR REHABILITATIONIt is essential for rehabilitation professionals to conduct follow-up services after distributing assistive devices among persons with disabilities.There is a need for the government of Bangladesh to revisit the Rights and Protection of Persons with Disability Act of 2013 and provide further clarity about their commitment to the provision of assistive devices and associated services (e.g., repair services) and its subsequent implementation.Policymakers in Bangladesh must be proactive to translate policy commitments into practice, as it relates to building an accessible environment for people using assistive devices. Further, government efforts are needed to educate policy implementers in all relevant ministries so that all responsible bodies are fully familiar with their national and international commitments regarding the rights of persons with disabilities.Future research could (i) include user's satisfaction with the service delivery process and (ii) measure the impact of assistive devices on family quality of life of persons with disabilities.
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Affiliation(s)
| | - Xiaolin Xu
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
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Valero JM, Satústegui PJ, Salavera CE, Sanz López V, Laborda AA, Hidalgo C. A systematic review on cross-cultural validations and psychometric solidity of the orthotics and prosthetics user survey. Prosthet Orthot Int 2024; 48:83-88. [PMID: 37639569 DOI: 10.1097/pxr.0000000000000268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 06/09/2023] [Indexed: 08/31/2023]
Abstract
Research is essential to reflect patients' satisfaction with their devices in the field of Prosthetics and Orthotics, record their performance and health-related quality of life. This requires culturally adapted questionnaires for each country. Periodic assessment of validity and test fit are essential elements for the long-term utility and effectiveness of psychometric tests. This article reviews the psychometric properties of the Orthotics and Prosthetics Users Survey (OPUS). The purpose, in addition to its adaptation to the Spanish-speaking population, involves a review/update of content, statistical analyses, and validity studies, until a larger number of studies are conducted. Study design: a Systematic review. A systematic literature search was carried out in specialized search engines: Alcorze (University of Zaragoza), MEDLINE (PubMed), and EMBASE of original articles published since 2000. Eleven items belonging to the OPUS were obtained, according to the language of the country where they were validated, and promising psychometric properties were confirmed (reflecting reliability values between 0.62 and 0.95; Cronbach's α scores between 0.73 and 0.98) with sample sizes between 10 and 321. The study concluded by stating that the OPUS was validated in different languages, reporting good psychometric robustness so far. Further deployment, refinement, and validation of this survey by country is warranted in view of its promising use.
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Affiliation(s)
- Julián M Valero
- PhD Candidate in Medicine, University of Zaragoza, Miguel Servet University Hospital, Professor YMCA, Zaragoza, Spain
| | | | - Carlos E Salavera
- Faculty of Education, Department of Developmental and Educational Psychology, University of Zaragoza, Zaragoza, Spain
| | - Vanessa Sanz López
- PhD Student in Health Sciences, University of Zaragoza. Professor Rey Ardid, Zaragoza, Spain
| | - Ana A Laborda
- PhD Student in Health Sciences, University of Zaragoza. Professor Rey Ardid, Zaragoza, Spain
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Shahabi S, Bagheri Lankarani K, Hoseeinabadi M, Heydari ST. Methodological and reporting quality of qualitative evidence in the field of lower limb orthoses: a systematic review. Assist Technol 2023; 35:532-550. [PMID: 37058228 DOI: 10.1080/10400435.2023.2199056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 04/15/2023] Open
Abstract
This study aimed to assess the methodological and reporting quality of qualitative studies conducted in the field of lower limb orthoses (LLOs). The following electronic databases were searched from inception to 2022: PubMed, Scopus, ProQuest, WoS, Embase, the Cochrane Central Register of Controlled Trials, and RehabData. Two authors independently screened and selected the potential studies. The methodological quality of included studies was assessed using the Critical Appraisal Skills Programs qualitative checklist. In addition, the reporting quality of included studies was assessed using the Standards for Reporting Qualitative Research (SRQR) tool. The mean methodological quality score of included studies was 8 (from min = 2 to max = 9.5), and most of the studies had a score of more than 7.5. However, SRQR findings revealed that the overall reporting quality of included studies was not desirable in that the mean score was about 15.44 (from min = 6 to max = 19.5) out of 21. In total, the methodological quality of qualitative studies published in the field of LLOs was moderate. Further, the adherence of these studies to available reporting guidelines was unsatisfactory. As a result, when designing, performing, and reporting qualitative investigations, authors should pay more attention to these criteria.
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Affiliation(s)
- Saeed Shahabi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Hoseeinabadi
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Taghi Heydari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Rates and correlates of psychological distress and PTSD among persons with physical disabilities in Cambodia. Int J Equity Health 2023; 22:30. [PMID: 36765360 PMCID: PMC9912539 DOI: 10.1186/s12939-023-01842-5] [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: 09/06/2022] [Accepted: 01/25/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Compared to the general population, persons with disabilities are at increased risk of poor mental health. The aim of this study was to determine the rates and correlates of psychological distress and post-traumatic stress disorder (PTSD) among persons with physical disabilities in Cambodia. METHODS From July to December 2021 data were collected as part of a mental health screening programme for persons with physical disabilities who access prosthetic and orthotic services. Psychological distress was measured using the Kessler-10 (K-10) and PTSD using the PC-PTSD-5. Bivariate and multiple linear regression analyses were conducted to identify factors associated with levels of psychological distress and PTSD among this population. RESULTS Our study found a high prevalence of psychological distress and PTSD in this patient cohort. Of the 213 participants, 31.5% were likely to be experiencing mild to moderate psychological distress indicative of a mental health disorder, with 13.6% likely to have a severe mental health disorder. Sixty-five percent of patients reported experiencing PTSD symptoms, with forty-six percent meeting the criteria for probable PTSD. Psychological distress was associated with pathological worry, rumination, and facets of mindfulness. Rumination and pathological worry were found to be significant predictors of psychological distress. PTSD symptoms were associated with pathological worry but not facets of mindfulness or rumination. Facets of mindfulness and pathological worry were found to be significant predictors of PTSD. CONCLUSION Integration of mental health services within the disability sector is required to address psychological distress and PTSD symptoms among people with physical disabilities in Cambodia. Health system interventions, such as screening, referral, and the training of health providers, need to be strengthened. Further studies focussing on the psychosocial determinants of mental health of persons with disabilities in Cambodia are required.
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Morgado Ramirez DZ, Nakandi B, Ssekitoleko R, Ackers L, Mwaka E, Kenney L, Holloway C, Donovan-Hall M. The lived experience of people with upper limb absence living in Uganda: A qualitative study. Afr J Disabil 2022; 11:890. [PMID: 35747758 PMCID: PMC9210140 DOI: 10.4102/ajod.v11i0.890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 01/19/2022] [Indexed: 11/08/2022] Open
Abstract
Background The impact of upper limb absence on people's lived experiences is understudied, particularly in African countries, with implications for policy and service design. Objectives The objective of this study was to explore the lived experiences of people with upper limb absence (PWULA) living in Uganda. Method Informed by preliminary work, we designed a qualitative study employing semi-structured interviews to understand the experience of living with upper limb absence in Uganda. Seventeen adults with upper limb absence were individually interviewed and their interviews were analysed utilising thematic analysis. Results Seven themes illustrating the impact on the individual's life after amputation were identified and categorised into (1) living and adapting to life, (2) productivity and participation and (3) living within the wider environment. This study presents three main findings: (1) PWULA need psychological and occupational support services which are not available in Uganda, (2) PWULA want to work, but face multiple barriers to employment and has limited support, combined with the complex parenting and caring responsibilities, (3) the local Ugandan culture and social structures affect the everyday life of PWULA, both in positive and negative ways. Conclusion This study provides information on the lived experiences of PWULA in Uganda which are lacking in the literature. People with upper limb absence face ableism and hardship underpinned by a lack of formal support structures and policies, which may in turn exacerbate the impact of upper limb absence on multiple facets of life.
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Affiliation(s)
- Dafne Zuleima Morgado Ramirez
- Interaction Centre, Department of Computer Science, Faculty of Engineering, University College London, London, United Kingdom
- Global Disability Innovation Hub, London, United Kingdom
| | - Brenda Nakandi
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Robert Ssekitoleko
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Louise Ackers
- School of Health and Society, University of Salford, Salford, United Kingdom
| | - Erisa Mwaka
- Department of Anatomy, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Laurence Kenney
- Centre for Health Sciences Research, University of Salford, Salford, United Kingdom
| | - Cathy Holloway
- Interaction Centre, Department of Computer Science, Faculty of Engineering, University College London, London, United Kingdom
- Global Disability Innovation Hub, London, United Kingdom
| | - Maggie Donovan-Hall
- School of Health Sciences, Faculty of Life and Environmental Sciences, University of Southampton, Southampton, United Kingdom
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