A Report on Disability and Rehabilitation Medicine in Pakistan: Past, Present, and Future Directions

Rathore, Farooq Azam; New, Peter W; Iftikhar, Amal

doi:10.1016/j.apmr.2010.10.004

Cited by 57 publications

(62 citation statements)

References 16 publications

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“…The scenario is worst in lower income countries, particularly in sub-Saharan Africa, Asia and Latin America [1, 24, 32, 53, 64, 65]. Among countries which report data on rehabilitation workers, ratios vary from <0.01 per 10 000 population in low-income countries to up to 25 per 10 000 population in high-income countries [1, 24, 25, 32, 53].…”

Section: Resultsmentioning

confidence: 99%

Human resources for health (and rehabilitation): Six Rehab-Workforce Challenges for the century

et al. 2017

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BackgroundPeople with disabilities face challenges accessing basic rehabilitation health care. In 2006, the United Nations Convention on the Rights of Persons with Disabilities (CRPD) outlined the global necessity to meet the rehabilitation needs of people with disabilities, but this goal is often challenged by the undersupply and inequitable distribution of rehabilitation workers. While the aggregate study and monitoring of the physical rehabilitation workforce has been mostly ignored by researchers or policy-makers, this paper aims to present the ‘challenges and opportunities’ for guiding further long-term research and policies on developing the relatively neglected, highly heterogeneous physical rehabilitation workforce.MethodsThe challenges were identified through a two-phased investigation. Phase 1: critical review of the rehabilitation workforce literature, organized by the availability, accessibility, acceptability and quality (AAAQ) framework. Phase 2: integrate reviewed data into a SWOT framework to identify the strengths and opportunities to be maximized and the weaknesses and threats to be overcome.ResultsThe critical review and SWOT analysis have identified the following global situation: (i) needs-based shortages and lack of access to rehabilitation workers, particularly in lower income countries and in rural/remote areas; (ii) deficiencies in the data sources and monitoring structures; and (iii) few exemplary innovations, of both national and international scope, that may help reduce supply-side shortages in underserved areas.DiscussionBased on the results, we have prioritized the following ‘Six Rehab-Workforce Challenges’: (1) monitoring supply requirements: accounting for rehabilitation needs and demand; (2) supply data sources: the need for structural improvements; (3) ensuring the study of a whole rehabilitation workforce (i.e. not focused on single professions), including across service levels; (4) staffing underserved locations: the rising of education, attractiveness and tele-service; (5) adapt policy options to different contexts (e.g. rural vs urban), even within a country; and (6) develop international solutions, within an interdependent world.ConclusionsConcrete examples of feasible local, global and research action toward meeting the Six Rehab-Workforce Challenges are provided. Altogether, these may help advance a policy and research agenda for ensuring that an adequate rehabilitation workforce can meet the current and future rehabilitation health needs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12960-017-0182-7) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Human resources for health (and rehabilitation): Six Rehab-Workforce Challenges for the century

et al. 2017

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“…There are no inpatient rehabilitation services or organized chronic home support services, and the stroke caregiver is often a close family member [13]. We aim to describe the QOL of stroke survivors and their caregivers in Pakistan, where the realities and context of care differ from other health care systems.…”

Section: Introductionmentioning

confidence: 99%

Quality of life after stroke in Pakistan

et al. 2016

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BackgroundThere is very little information about the quality of life (QOL) of stroke survivors in LMIC countries with underdeveloped non communicable health infrastructures, who bear two thirds of the global stroke burden.MethodologyWe used a sequential mix methods approach. First, a quantitative analytical cross-sectional study was conducted on 700 participants, who constituted 350 stroke survivor and their caregiver dyads. QOL of stroke survivor was assessed via Stroke Specific Quality of Life Scale (SSQOLS) whereas QOL of caregivers was assessed through RAND-36. In addition; we assessed complications, psychosocial and functional disability of stroke survivors. Following this quantitative survey, caregivers were qualitatively interviewed to uncover contextually relevant themes that would evade quantitative surveys. Multiple linear regression technique was applied to report adjusted β-coefficients with 95% C.I.ResultsThe QOL study was conducted from January 2014 till June 2014, in two large private and public centers. At each center, 175 dyads were interviewed to ensure representativeness. Median age of stroke survivors was 59(17) years, 68% were male, 60% reported depression and 70% suffered post-stroke complications. The mean SSQOLS score was 164.18 ± 32.30. In the final model severe functional disability [adjβ -33.77(-52.44, -15.22)], depression [adjβ-23.74(-30.61,-16.82)], hospital admissions [adjβ-5.51(-9.23,-1.92)] and severe neurologic pain [adjβ -12.41(-20.10,-4.77)] negatively impacted QOL of stroke survivors (P < 0.01).For caregivers, mean age was 39.18 ± 13.44 years, 51% were female and 34% reported high stress levels. Complementary qualitative study revealed that primary caregivers were depressed, frustrated, isolated and also disappointed by health services.ConclusionThe QOL of Stroke survivors as reported by SSQOLS score was better than compared to those reported from other LMIC settings. However, Qualitative triangulation revealed that younger caregivers felt isolated, depressed, overwhelmed and were providing care at great personal cost. There is a need to develop cost effective holistic home support interventions to improve lives of the survivor dyad as a unit.Trial registration NCT02351778 (Registered as Observational Study).Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-016-0774-1) contains supplementary material, which is available to authorized users.

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“…9 In Pakistan, disabled persons are often concealed in the home because disability is believed to bring guilt and shame upon a family. 41,42 Such situations may foster depression and limit motivation towards self-care. Indeed, psychological comorbidities such as depression and anxiety themselves may foster PU development.…”

Section: Pressure Ulcers In Developing Nationsmentioning

confidence: 99%

“…66 On the other hand, too much family involvement can actually impair the development of independence of the individual with SCI. 42 Pressure relief surfaces. In addition to pressure relief maneuvers, pressure relief surfaces also has a large role in preventing pressure ulceration.…”

Section: Pressure Ulcers In Developing Nationsmentioning

confidence: 99%

Pressure ulcers in people with spinal cord injury in developing nations

2014

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Study design: Literature review. Objectives: To explore the prevalence or incidence, risk factors, and costs of pressure ulcers among individuals with spinal cord injury (SCI), specifically in the context of the developing world. To highlight important targets for intervention and research for pressure ulcer management the world over. Setting: World Bank 'low-income' and 'middle-income' countries with a gross national income per capita o$12 746. Methods: PubMed search. Results: SCI-associated pressure ulcers are very prevalent in developing nations; however, reported prevalence and incidence numbers are highly variable. Risk factors for pressure ulcers are similar in developed and developing countries however many of the risk factors are more prevalent in developing nations. Conclusion: SCI-associated pressure ulcers are common but can be prevented in the developing world. Key targets for interventions include acute care, nurse-to-patient ratios, support surfaces and education.

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A Report on Disability and Rehabilitation Medicine in Pakistan: Past, Present, and Future Directions

Cited by 57 publications

References 16 publications

Human resources for health (and rehabilitation): Six Rehab-Workforce Challenges for the century

Human resources for health (and rehabilitation): Six Rehab-Workforce Challenges for the century

Quality of life after stroke in Pakistan

Pressure ulcers in people with spinal cord injury in developing nations

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