1
|
Baruah U, Sharma P, Thomas PT, Dhamija RK. Neuropalliative Care in India - Barriers, Challenges and Future Directions. Ann Indian Acad Neurol 2023; 26:107-111. [PMID: 37179665 PMCID: PMC10171018 DOI: 10.4103/aian.aian_1021_22] [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: 12/27/2022] [Revised: 02/04/2023] [Accepted: 02/13/2023] [Indexed: 03/31/2023] Open
Abstract
Neuropalliative care is an emerging sub-specialty of neurology and palliative care that aims to relieve suffering from symptoms, reduce distress and improve the quality of life of people with life-limiting neurological conditions and their family caregivers. As advances are being made in the prevention, diagnosis, and treatment of neurological illnesses, there is an increasing need to guide and support patients and their families through complex choices involving immense uncertainty and important life-changing outcomes. The unmet need for palliative care in neurological illnesses is high, especially in a low-resource setting like India. This article discusses the scope of neuropalliative care in India, the barriers and challenges that impede the specialty's development, and the factors that could facilitate the development and scale-up delivery of neuropalliative services. The article also attempts to highlight priority areas for advancing neuropalliative care in India which include context-specific assessment tools, sensitization of the healthcare system, identification of intervention outcomes, the need for developing culturally sensitive models based on home-based or community-based care, evidence-based practices, and development of manpower and training resources.
Collapse
Affiliation(s)
- Upasana Baruah
- Department of Psychiatric Social Work, Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India
| | - Prerna Sharma
- Clinical Psychology, Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India
| | - Priya Treesa Thomas
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | | |
Collapse
|
2
|
Dhavala A, Samitinjay A, Khairkar P, Podder V, Price A, Fatima SH, Biswas R. Integrated case-based clinical approach in understanding pathways, complexities, pitfalls and challenges in neurodegenerative disorders. AMERICAN JOURNAL OF NEURODEGENERATIVE DISEASE 2022; 11:22-33. [PMID: 35874938 PMCID: PMC9301093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION This paper presents 5 cases of neurodegenerative disorders from our tertiary care rural hospital in south India. The purpose of this paper is to generate an emerging common theme by thematic analysis of clinical data from each of these patients. A theme emerged, we identified that there was a common clinical ground in patients with movement disorders and psychiatric symptoms. From this common theme, these patients eventually went on to develop different courses of illnesses. METHODOLOGY Clinical analysis of a case series of 5 patients with neurodegenerative disorders attending the Medicine or Psychiatry services of our hospital. CONCLUSION A clear & consistent association between movement disorders and psychiatric symptoms was found. Although our data is limited, we conclude that movement disorders can be early clinical markers of organic psychopathology. However, we are aware that this association can be confounded by substance abuse, stress, sleep disruption and even therapeutic interventions, and thus these factors were accounted for and yet we conclude that movement disorders can be early clinical indictors of organic psychopathology.
Collapse
Affiliation(s)
- Aashitha Dhavala
- Junior Resident in General Medicine, Kamineni Institute of Medical SciencesNarketpally, India
| | - Aditya Samitinjay
- Senior Resident in General Medicine, Government General & Chest HospitalErragada, Hyderabad, India
| | - Praveen Khairkar
- HOD & Professor in Psychiatry, Kamineni Institute of Medical SciencesNarketpally, India
| | - Vivek Podder
- Visiting Lecturer, The University of AdelaideAustralia
| | - Amy Price
- Senior Research Scientist Stanford School of MedicineCA, USA
| | - Syeda Hira Fatima
- Junior Resident in Psychiatry, Kamineni Institute of Medical SciencesNarketpally, India
| | - Rakesh Biswas
- HOD & Professor in General Medicine, Kamineni Institute of Medical SciencesNarketpally 508254, India
| |
Collapse
|
3
|
Singh G, Sharma M, Kumar GA, Rao NG, Prasad K, Mathur P, Pandian JD, Steinmetz JD, Biswas A, Pal PK, Prakash S, Sylaja PN, Nichols E, Dua T, Kaur H, Alladi S, Agarwal V, Aggarwal S, Ambekar A, Bagepally BS, Banerjee TK, Bender RG, Bhagwat S, Bhargava S, Bhatia R, Chakma JK, Chowdhary N, Dey S, Dirac MA, Feigin VL, Ganguli A, Golechha MJ, Gourie-Devi M, Goyal V, Gupta G, Gupta PC, Gupta R, Gururaj G, Hemalatha R, Jeemon P, Johnson CO, Joshi P, Kant R, Kataki AC, Khurana D, Krishnankutty RP, Kyu HH, Lim SS, Lodha R, Ma R, Malhotra R, Malhotra R, Mathai M, Mehrotra R, Misra UK, Mutreja P, Naghavi M, Naik N, Nguyen M, Pandey A, Parmar P, Perianayagam A, Prabhakaran D, Rath GK, Reinig N, Roth GA, Sagar R, Sankar MJ, Shaji KS, Sharma RS, Sharma S, Singh R, Srivastava MVP, Stark BA, Tandon N, Thakur JS, ThekkePurakkal AS, Thomas SV, Tripathi M, Vongpradith A, Wunrow HY, Xavier D, Shukla DK, Reddy KS, Panda S, Dandona R, Murray CJL, Vos T, Dhaliwal RS, Dandona L. The burden of neurological disorders across the states of India: the Global Burden of Disease Study 1990-2019. Lancet Glob Health 2021; 9:e1129-e1144. [PMID: 34273302 PMCID: PMC8295043 DOI: 10.1016/s2214-109x(21)00164-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/18/2021] [Accepted: 03/08/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND A systematic understanding of the burden of neurological disorders at the subnational level is not readily available for India. We present a comprehensive analysis of the disease burden and trends of neurological disorders at the state level in India. METHODS Using all accessible data from multiple sources, we estimated the prevalence or incidence and disability-adjusted life-years (DALYs) for neurological disorders from 1990 to 2019 for all states of India as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. We assessed the contribution of each neurological disorder to deaths and DALYs in India in 2019, their trends in prevalence or incidence and DALY rates over time, and heterogeneity between the states of India. We also assessed the Pearson correlation coefficient between Socio-demographic Index (SDI) of the states and the prevalence or incidence and DALY rates of each neurological disorder. Additionally, we estimated the contribution of known risk factors to DALYs from neurological disorders. We calculated 95% uncertainty intervals (UIs) for the mean estimates. FINDINGS The contribution of non-communicable neurological disorders to total DALYs in India doubled from 4·0% (95% UI 3·2-5·0) in 1990 to 8·2% (6·6-10·2) in 2019, and the contribution of injury-related neurological disorders increased from 0·2% (0·2-0·3) to 0·6% (0·5-0·7). Conversely, the contribution of communicable neurological disorders decreased from 4·1% (3·5-4·8) to 1·1% (0·9-1·5) during the same period. In 2019, the largest contributors to the total neurological disorder DALYs in India were stroke (37·9% [29·9-46·1]), headache disorders (17·5% [3·6-32·5]), epilepsy (11·3% [9·0-14·3]), cerebral palsy (5·7% [4·2-7·7]), and encephalitis (5·3% [3·7-8·9]). The crude DALY rate of several neurological disorders had considerable heterogeneity between the states in 2019, with the highest variation for tetanus (93·2 times), meningitis (8·3 times), and stroke (5·5 times). SDI of the states had a moderate significant negative correlation with communicable neurological disorder DALY rate and a moderate significant positive correlation with injury-related neurological disorder DALY rate in 2019. For most of the non-communicable neurological disorders, there was an increase in prevalence or incidence from 1990 to 2019. Substantial decreases were evident in the incidence and DALY rates of communicable neurological disorders during the same period. Migraine and multiple sclerosis were more prevalent among females than males and traumatic brain injuries were more common among males than females in 2019. Communicable diseases contributed to the majority of total neurological disorder DALYs in children younger than 5 years, and non-communicable neurological disorders were the highest contributor in all other age groups. In 2019, the leading risk factors contributing to DALYs due to non-communicable neurological disorders in India included high systolic blood pressure, air pollution, dietary risks, high fasting plasma glucose, and high body-mass index. For communicable disorders, the identified risk factors with modest contributions to DALYs were low birthweight and short gestation and air pollution. INTERPRETATION The increasing contribution of non-communicable and injury-related neurological disorders to the overall disease burden in India, and the substantial state-level variation in the burden of many neurological disorders highlight the need for state-specific health system responses to address the gaps in neurology services related to awareness, early identification, treatment, and rehabilitation. FUNDING Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.
Collapse
|
4
|
Dhamija RK, Srivastava A, Chauhan S, Shah U, Nagda T, Palande D, Chitnis S, Dantala PS, Solomon JM, Krishnan SM, Someshwar H, Surya N. Consensus Statement on Neurorehabilitation during COVID-19 Times: Expert Group on Behalf of the Indian Federation of Neurorehabilitation (IFNR). Ann Indian Acad Neurol 2021; 24:138-141. [PMID: 34220054 PMCID: PMC8232470 DOI: 10.4103/aian.aian_997_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/29/2020] [Accepted: 10/03/2020] [Indexed: 11/04/2022] Open
Abstract
The COVID19 pandemic in India is causing significant morbidity and disruptions of healthcare delivery. The rapidly escalating contagion is straining our public health system, which is already under pressure due to a shortage of infrastructure and inadequate workforce. Neuro rehabilitation services that are still in its infancy in our country have been significantly interrupted in the last six months. An expert group from Indian Federation of Neurorehabilitation (IFNR) have formulated the guidelines and consensus recommendations for Neurologists, Physiatrists, and Therapists managing neurological disabilities during COVID 19. The aim of this consensus paper is to sensitize the clinicians and therapists about maintaining the continuum of care and rehabilitation needs of Covid patients as well as non Covid patients with neurological disorders during the ongoing COVID 19 pandemic.
Collapse
Affiliation(s)
- Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College and SSK Hospital, New Delhi, India
| | - Abhishek Srivastava
- Centre for Physical Medicine and Rehabilitation, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Sonal Chauhan
- Department of Physical Medicine and Rehabiltation, Lady Hardinge Medical College and SSK Hospital, New Delhi, India
| | - Urvashi Shah
- Center for Neuropsychology Studies, Department of Neurology, KEM Hospital, Mumbai, Maharashtra, India
| | - Taral Nagda
- Department of Pediatric Orthopaedics, NH SRCC Children's Hospital, Mumbai, Maharashtra, India
| | - Deepak Palande
- Department of Neurosurgery, Sir J J Hospital and Grant Government Medical College, Mumbai, Maharashtra, India
| | - Sonal Chitnis
- School of Audiology Speech and Language Pathology, Bharati Vidyapeeth (DU) Medical College, Pune, Maharashtra, India
| | - P S Dantala
- Department of Orthotics, Dhyan Health Care, Mumbai, Maharashtra, India
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Karnataka, India
| | - S Murali Krishnan
- Faculty of Occupational Therapy, Meenakshi Academy of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Hitav Someshwar
- Department of Neurophysiotherapy, KJ Somaiya College of Physiotherapy, Mumbai, Maharashtra, India
| | - Nirmal Surya
- Indian Federation of Neurorehabilitation, Surya Neuro Centre, Mumbai, Maharashtra, India
| |
Collapse
|
5
|
Sinha AG, Sharma R. Factors Influencing Utilization of Physiotherapy Service among Children with Cerebral Palsy in Jalandhar District of Punjab. J Neurosci Rural Pract 2019; 8:209-215. [PMID: 28479794 PMCID: PMC5402486 DOI: 10.4103/0976-3147.203852] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Physiotherapy plays a central role in the management of children with cerebral palsy (CP); however, literature describing the use of physiotherapy service and the factors affecting utilization of physiotherapy service for this group of children in the Indian context remain unexplored. Aims and Objectives: To describe the utilization of physiotherapy services and explore the factors affecting utilization of physiotherapy services among children with CP of Jalandhar district of Punjab. Methodology: During June 2009 to March 2012 interview of family members of 248 children with CP (male = 159; female = 89) was conducted using a schedule focusing on demography, constraints of resources, expectations, beliefs, awareness, and service utilization. Cross tabulation with Chi-square, univariate, and multivariate logistic regression analysis were the tools of statistical analysis. Results: 44.4% children had not received any physiotherapy in their life time. In univariate analysis exposure to physiotherapy was found significantly associated with age of diagnosis (odds ratio [OR] = 2.47), finance constraint (OR = 2.27), personal constraint (OR = 2.54), transportation constraint (OR = 3.01), lack of advice for rehabilitation (OR = 2.36), ignorance about condition (OR = 11.94), and rehabilitation services (OR = 2.88). Multivariate model (χ2 = 57.16, df = 15, P < 0.001, pseudo R2 Cox and Snell = 0.22, Nagelkerke = 0.27) identified two main predictor variables of nonexposure to physiotherapy-ignorance about condition (OR = 7.3) and expectation of normalcy (OR = 0.43). Conclusion: The main drivers for the use of physiotherapy among children with CP in Jalandhar district of Punjab were awareness about the condition of CP and expectation of normalcy which demonstrated a complex relationship with sociodemographic factors.
Collapse
Affiliation(s)
- Akhoury Gourang Sinha
- Department of Physiotherapy, Faculty of Medicine, Punjabi University, Patiala, Punjab, India
| | - Raju Sharma
- Department of Physiotherapy, Lyallpur Khalsa College, Jalandhar, Punjab, India
| |
Collapse
|
6
|
Jindal P, Macdermid JC, Rosenbaum P, Direzze B, Narayan A, Nayak SL. Treatment and re/habilitation of children with cerebral palsy in India: a scoping review. Dev Med Child Neurol 2019; 61:1050-1060. [PMID: 30883735 DOI: 10.1111/dmcn.14211] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2019] [Indexed: 11/27/2022]
Abstract
AIM To describe the nature and extent of the literature addressing the medical and its re/habilitative management of cerebral palsy (CP) in India. METHOD Online worldwide scholarly databases, research hosting directories, Indian publishing houses, and grey literature were used to identify papers published between 2005 and 2016. We retrieved 144 English language papers that described the medical and rehabilitative management of Indian children with CP. RESULTS Quantitative, qualitative, and mixed research designs are published by a variety of health care professionals in India. Intervention (45%) and observational studies (30%) predominate. Outcomes were categorized using the World Health Organization's International Classification of Functioning, Disability and Health framework, with body structure and function most reported and activity/participation least reported; 57% described its re/habilitation interventions and 43% were medical interventions. INTERPRETATION There is a substantial body of CP research in India that focuses on interventions to reduce impairments, with minimal attention given to activities and participation, environmental, and personal factors. Twenty-six per cent of studies are published in what appear to be 'predatory journals'. This paper serves as an alert about the presence of 'predatory journals' in medicine that may introduce publication bias, which can distort results reported in those studies individually, or from conclusions drawn in reviews that contain those studies. WHAT THIS PAPER ADDS Cerebral palsy research in India focuses on interventions to reduce impairment. Activities, participation, and environmental factors are minimally addressed. Quantitative studies are more common than qualitative studies. Many Indian studies are published in journals that are not indexed in worldwide databases of scholarly journals.
Collapse
Affiliation(s)
- Pranay Jindal
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Joy C Macdermid
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,School of Physical Therapy, University of Western Ontario, London, Ontario, Canada.,Clinical Research Laboratory, St. Joseph's Health Centre, London, Ontario, Canada
| | - Peter Rosenbaum
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.,Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Briano Direzze
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Amitesh Narayan
- Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangalore, India
| | | |
Collapse
|
7
|
Ezejimofor M, Biu A, Uthman OA. Estimating the uptake of brain imaging and 30-days stroke mortality in Nigeria: A meta-analysis of hospital-based studies. J Neurol Sci 2018; 394:6-13. [PMID: 30196133 DOI: 10.1016/j.jns.2018.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/29/2018] [Accepted: 08/22/2018] [Indexed: 01/10/2023]
Abstract
PURPOSE This study aims to estimate the computed tomography (CT) and Magnetic resonance imaging (MRI) uptake, stroke subtypes and 30-days case-fatality in Nigeria. METHODS Stroke diagnosis and mortality data were identified from relevant databases. A random effect meta-analysis was conducted to obtain the pooled percentage uptake of CT/MRI, including 30-days case fatality and a meta-regression-like epidemiological model was applied on all data points. FINDINGS A total of 24 studies involving 5874 stroke patients conducted in predominantly tertiary referral hospitals met the inclusion criteria. The pooled CT/MRI uptake in the last seven years was 46.66% (95% CI = 15.35 to 77.98, 8 studies). There were significant variations in the prevalence of stroke subtypes. The pooled prevalence ischemic stroke was highest (55.32%, 95% CI 48.67 to 61.97, 16 studies), followed by intracerebral haemorrhage (ICH) (32.69%, 95% CI 25.54 to 39.83, 16 studies), subarachnoid haemorrhage (SAH) (3.76%, 95% CI 2.30 to 5.22, 14 studies). In addition, the stroke of undetermined aetiology was found to be 16.57% (95% CI, 7.44-25.70, 8 studies). Overall, the 24-h, one-week and 30-days case-fatality from stroke were 10.84% (95% CI, 4.48-17.20), 24.62% (95% CI, 17.20-32.04) and 33.28% (95% CI, 27.80-38.77), respectively. There was a moderate negative correlation between prevalence of brain imaging uptake and ischaemic stroke, albeit not statistically significant (Spearman rho = 0.333, p-value = .412). CONCLUSION Uptake of CT/MRI procedure for stroke is poor in Nigeria. Although poverty, inaccessibility and influence of major risk factors remain pronounced, scaling up of effective strategies for stroke prevention and management should be a major public health policy priority in Nigeria.
Collapse
Affiliation(s)
- Martinsixtus Ezejimofor
- Division of Health Sciences, University of Warwick Medical School, Coventry, UK; British Association of Dermatologist, Willan House, Fitzroy Square, London W1T 5HQ, UK.
| | - Amabetare Biu
- Community Children's Health Partnership (CCHP), Sirona Care and Health, Southmead, Bristol, UK
| | - Olalekan A Uthman
- Division of Health Sciences, University of Warwick Medical School, Coventry, UK
| |
Collapse
|
8
|
Mishra K, Siddharth V. Utilization of institutional rehabilitation service in pediatric patients with disability in Southwest Rajasthan. J Family Med Prim Care 2018; 7:703-708. [PMID: 30234041 PMCID: PMC6132008 DOI: 10.4103/jfmpc.jfmpc_260_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Rehabilitating disabled child maximizes functional independence, thereby, enhancing the quality of life and better community participation. Utilization of rehabilitation services is a significant issue in developing countries like India. This study aims to observe the pattern of utilization of institutional rehabilitation services by pediatric patients with disability. Methods: This was an observational study (descriptive cross-sectional study) conducted at Department of Physical Medicine and Rehabilitation in a tertiary care set-up. Descriptive data from an ongoing study involving children with and without developmental delay (DD) over 1 year were collected in terms of age, gender, distance from the institute, diagnosis, and frequency of visit. Utilization pattern for rehabilitation services among pediatric patients was analyzed with respect to diagnosis and frequency of visit under each diagnosed category. The demographic variable of age, gender, and distance from the institute was further correlated to frequency of visit. IBM SPSS statistics 22 was used for descriptive statistical analysis and correlation of variables. Results: Of 464 disabled children using rehabilitation service, data for 399 (M: 255, F: 144) children were complete with age ranging from 3 months to 18 years and distance from 1 km to 600 km from institute. There were 330 children with DD and 69 in non-DD category. Two hundred and sixty-eight cases used one-time consultancy, 86 preferred intermittent services, and 45 patients were regular. Negligible correlation with a trend toward negative values was observed between frequency of service utilization and distance (Rho = −0.139 Sig. = 0.006, at 0.01 level) and between age and utilization frequency (Rho = −0.074, Sig = 0.140). Conclusions: The study showed that children with DD were main utilizers of rehabilitation services. Nearly 67% of disabled children utilized services only once with a trend toward younger age group and those nearer to institute were noted.
Collapse
Affiliation(s)
- Kriti Mishra
- Department of Physical Medicine and Rehabilitation, All India Institute Of Medical Sciences, Jodhpur, Rajasthan, India
| | - V Siddharth
- Department of Physical Medicine and Rehabilitation, All India Institute Of Medical Sciences, Jodhpur, Rajasthan, India
| |
Collapse
|
9
|
Jindal P, MacDermid JC, Rosenbaum P, DiRezze B, Narayan A. Perspectives on rehabilitation of children with cerebral palsy: exploring a cross-cultural view of parents from India and Canada using the international classification of functioning, disability and health. Disabil Rehabil 2017; 40:2745-2755. [PMID: 28747138 DOI: 10.1080/09638288.2017.1356383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To explore parents' perspectives on rehabilitation of their child with cerebral palsy and their information needs. METHODS Semistructured interviews were conducted with parents of children with CP from India (n = 11) and Canada (n = 7). Data were analyzed through an interpretive description approach using the International Classification of Functioning, Disability and Health framework. RESULTS Body Structure and Function: Indian parents were more focused on fixing body structure and function challenges, and independent walking, than Canadian parents. Activity and Participation: All Canadian children were actively involved in school and fun activities in the community. Due to lack of accessible services, Indian children had less school and community participation. Environmental factors: accessible communities, occupational therapy services and greater use of assistive devices enabled Canadian children. Social and cultural beliefs, lack of access to services and inaccessible communities were the barriers experienced by Indian parents. Information needs: both groups needed information to make their child more functional. CONCLUSION Canadian parents experience a more enabling environment and express a more social view of their child's health, suggesting both education on the International Classification of Functioning, Disability and Health principles and services are needed to better enable and empower Indian parents. There remains a need for healthcare professionals and services in both countries to be more family-centered. Implications for rehabilitation To help parents in rehabilitating their children with cerebral palsy (CP), in India, there is a need to (1) incorporate ICF education into medical curricula and clinical practice; (2) increase the availability of skilled healthcare professionals and centers; (3) make infrastructural and policy reforms to make the society more accessible for the disabled children. Education, counseling and awareness about CP might help both groups of parents, society, and HCPs to change their beliefs and attitudes regarding CP and its rehabilitation. Both countries would benefit from user-friendly and transparent policies. This will help parents to become more aware of them and use them in the rehabilitation process.
Collapse
Affiliation(s)
- Pranay Jindal
- a School of Rehabilitation Science , McMaster University , Hamilton , Canada.,b CanChild Centre for Childhood Disability Research , McMaster University , Hamilton , Canada
| | - Joy C MacDermid
- a School of Rehabilitation Science , McMaster University , Hamilton , Canada
| | - Peter Rosenbaum
- a School of Rehabilitation Science , McMaster University , Hamilton , Canada.,b CanChild Centre for Childhood Disability Research , McMaster University , Hamilton , Canada.,c Department of Paediatrics , McMaster University , Hamilton , Canada
| | - Briano DiRezze
- a School of Rehabilitation Science , McMaster University , Hamilton , Canada.,b CanChild Centre for Childhood Disability Research , McMaster University , Hamilton , Canada
| | - Amitesh Narayan
- d Department of Physiotherapy , Kasturba Medical College, Manipal University , Mangalore , India
| |
Collapse
|
10
|
Sureshkumar K, Murthy GVS, Kinra S, Goenka S, Kuper H. Development and evaluation of a Smartphone-enabled, caregiver-supported educational intervention for management of physical disabilities following stroke in India: protocol for a formative research study. ACTA ACUST UNITED AC 2015; 1:117-126. [PMID: 26751379 PMCID: PMC4687506 DOI: 10.1136/bmjinnov-2015-000042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The incidence and prevalence of stroke in India has reached epidemic proportions. The growing magnitude of disability in patients with stroke in India poses a major public health challenge. Given the nature of the condition, affected individuals often become disabled with profound effects on their quality of life. The availability of rehabilitation services for people with disabilities is inadequate in India. Rehabilitation services are usually offered by private hospitals located in urban areas and many stroke survivors, especially those who are poor or live in rural areas, cannot afford to pay for, or do not have access to, such services. Thus, identification of cost-effective ways to rehabilitate people with stroke-related disability is an important challenge. Educational interventions in stroke rehabilitation can assist stroke survivors to make informed decisions regarding their on-going treatment and to self-manage their condition with support from their caregivers. Although educational interventions have been shown to improve patient knowledge for self-management of stroke, an optimal format for the intervention has not as yet been established, particularly in low- and middle-income countries. This formative research study aims to systematically develop an educational intervention for management of post-stroke disability for stroke survivors in India, and evaluate the feasibility and acceptability of delivering the intervention using Smartphones and with caregiver support. The research study will be conducted in Chennai, India, and will be organised in three different phases. Phase 1: Development of the intervention. Phase 2: Field testing and finalising the intervention. Phase 3: Piloting of the intervention and assessment of feasibility and acceptability. A mixed-methods approach will be used to develop and evaluate the intervention. If successful, it will help realise the potential of using Smartphone-enabled, carer-supported educational intervention to bridge the gaps in service access for rehabilitation of individuals with stroke-related disability in India. The proposed research will also provide valuable information for clinicians and policymakers.
Collapse
Affiliation(s)
- K Sureshkumar
- International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene and Tropical Medicine , London , UK
| | - G V S Murthy
- International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene and Tropical Medicine , London , UK
| | - Sanjay Kinra
- Department of Non-Communicable Disease, Epidemiology, London School of Hygiene and Tropical Medicine , London , UK
| | | | - Hannah Kuper
- International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene and Tropical Medicine , London , UK
| |
Collapse
|
11
|
Influence of socio-economic status on access to different components of SCI management across Indian population. Spinal Cord 2015; 53:816-20. [PMID: 26017056 DOI: 10.1038/sc.2015.80] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 04/04/2015] [Accepted: 04/08/2015] [Indexed: 11/08/2022]
|
12
|
Cost and burden of informal caregiving of dependent older people in a rural Indian community. BMC Health Serv Res 2014; 14:207. [PMID: 24886051 PMCID: PMC4022434 DOI: 10.1186/1472-6963-14-207] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lack of state supported care services begets the informal caregiving by family members as the mainstay of care provided to the dependent older people in many Low and Middle Income Countries (LMICs), including India. Little is known about the time spent on caregiving, its cost and the burden experienced by these informal caregivers. We aimed to estimate the costs of informal caregiving and to evaluate the nature as well as correlates of caregivers' burden in a rural Indian community. METHODS We assessed 1000 people aged above 65 years, among whom 85 were dependent. We assessed their socioeconomic profiles, disability, health status and health expenditures. Their caregivers' socio-demographic profiles, mental health, and the time spent on caregiving were assessed using standard instruments. Caregiver's burden was evaluated using Zarit Burden Scale. We valued the annual informal caregiving costs using proxy good method. We employed appropriate non-parametric multivariate statistics to evaluate the correlates of caregivers' burden. RESULTS Average time spent on informal caregiving was 38.6 (95% CI 35.3-41.9) hours/week. Estimated annual cost of informal caregiving using proxy good method was 119,210 US$ in this rural community. Mean total score of Zarit burden scale, measuring caregivers' burden, was 17.9 (95% CI 15.6-20.2). Prevalence of depression among the caregivers was 10.6% (95% CI 4.1-17.1%). Cerebrovascular disease, Parkinson's disease, higher disability, insomnia and incontinence of the dependent older people as well as the time spent on helping Activities of Daily Living and on supervision increased caregiver's burden significantly. CONCLUSIONS Cost and burden of informal caregiving are high in this rural Indian community. Many correlates of burden, experienced by caregivers, are modifiable. We discuss potential strategies to reduce this burden in LMICs. Need for support to informal caregivers and for management of dependent older people with chronic disabling diseases by multidisciplinary community teams are highlighted.
Collapse
|
13
|
|
14
|
Chitambira B. Importance of preliminary epidemiology studies in rural areas of developing countries. J Neurosci Rural Pract 2012; 3:2-3. [PMID: 22346180 PMCID: PMC3271607 DOI: 10.4103/0976-3147.91920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Benjamin Chitambira
- Department of Physiotherapy, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, England, UK
| |
Collapse
|
15
|
Thomas R. Commentary. J Neurosci Rural Pract 2012; 3:16. [PMID: 22346184 PMCID: PMC3271605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Raji Thomas
- Department of PMR, Christian Medical College, Vellore, Tamil Nadu, India,Address for correspondence: Dr. Raji Thomas, Department of PMR, Christian Medical College, Vellore, Tamil Nadu, India. E-mail:
| |
Collapse
|