The NHV Rehabilitation Services Program Improves Long-Term Physical Functioning in Survivors of the 2008 Sichuan Earthquake: A Longitudinal Quasi Experiment

Abstract

BackgroundLong-term disability following natural disasters significantly burdens survivors and the impacted society. Nevertheless, medical rehabilitation programming has been historically neglected in disaster relief planning. ‘NHV’ is a rehabilitation services program comprised of non–governmental organizations (NGOs) (N), local health departments (H), and professional rehabilitation volunteers (V) which aims to improve long-term physical functioning in survivors of the 2008 Sichuan earthquake. We aimed to evaluate the effectiveness of the NHV program.Methods/Findings510 of 591 enrolled earthquake survivors participated in this longitudinal quasi-experimental study (86.3%). The early intervention group (NHV–E) consisted of 298 survivors who received institutional-based rehabilitation (IBR) followed by community-based rehabilitation (CBR); the late intervention group (NHV–L) was comprised of 101 survivors who began rehabilitation one year later. The control group of 111 earthquake survivors did not receive IBR/CBR. Physical functioning was assessed using the Barthel Index (BI). Data were analyzed with a mixed-effects Tobit regression model. Physical functioning was significantly increased in the NHV–E and NHV–L groups at follow-up but not in the control group after adjustment for gender, age, type of injury, and time to measurement. We found significant effects of both NHV (11.14, 95% CI 9.0–13.3) and sponaneaous recovery (5.03; 95% CI 1.73–8.34). The effect of NHV-E (11.3, 95% CI 9.0–13.7) was marginally greater than that of NHV-L (10.7, 95% CI 7.9–13.6). It could, however, not be determined whether specific IBR or CBR program components were effective since individual component exposures were not evaluated.ConclusionOur analysis shows that the NHV improved the long-term physical functioning of Sichuan earthquake survivors with disabling injuries. The comprehensive rehabilitation program benefitted the individual and society, rehabilitation services in China, and international rehabilitation disaster relief planning. Similar IBR/CBR programs should therefore be considered for future large-scale rehabilitation disaster relief efforts.

Rehabilitation of vulnerable groups in emergencies and disasters: A systematic review

“…[36,37] Disaster management experts believe that physical and physiological rehabilitation should be immediately started after response phase to disaster and it should continue in the community over the long term in order to improve and restore function of vulnerable peoples. [13,38,39] One of the studies emphasized social rehabilitation of vulnerable groups in order to ensure the participation of vulnerable groups in the planning and implementation World J Emerg Med, Vol 8, No 4, 2017 (2) intent to delegate responsibility; and (3) desire for a wide scope of social support.…”

“…The majority of them also did not consider important confounding factors. None of the randomized controlled trial articles reported blinding of participants or assessors and two studies [35,36] lacked a control group. More details have shown in Table 1.…”

“…Details of each study and their special features were reported regarding authors, year, study type, vulnerable group, sample size, type of rehabilitation, setting and duration of rehabilitation, disaster type, and main concepts. The studies were mainly conducted in Asian countries and United States, including India, [15,19,20,[25][26][27]31] China, [18,22,23,34,36,37] Pakistan, [16,28,30] Iran, [13,17,21] Indonesia, [29,32] Sri Lanka [35] and United States. [14,24,33] The results of the studies showed that 56% of the studies are about rehabilitation programs for women, 32% is for children, 24% is for elderly, and 16% is for disabled people.…”

“…Zhang et al [36] (2013) Zang et al [37] (2013) Vol 8, No 4, 2017 of services and activities from the day after the onset of the disaster based on the equal time and opportunity to governmental authorities and aid agencies. The strategies that can increase the participation of the vulnerable groups in meeting their needs include: (1) providing services with the cooperation of the people based on the capacity and potency; and (2) dependency of the vulnerable groups to the external services that should be gradually decreased.…”

Medical rehabilitation of spinal cord injury following earthquakes in rehabilitation resource-scarce settings: implications for disaster research

“…The NHV model also provided community-based rehabilitation and included a rehabilitation training and qualification program for local professionals, as well as tools for patient management and education. 28 Foreign medical teams (for example, Taiwan, Russia, Hong Kong, Japan, Italy, Germany, France, UK, USA and Cuba) spent 3 weeks in Sichuan, treating 24 410 cases at 11 sites, which included surgical and nursing care 29 as well as rehabilitative post-surgical care. Training of host medical services was also provided.…”