CITATION: Community-based rehabilitation for people with disabilities in low- and middle-income countries: A systematic review
by Valentina Iemmi, Lorna Gibson, Karl Blanchet et al.
International Initiative for Impact Evaluation (3ie), September 2015
SUMMARY: The authors reviewed the evidence about the impact of community-based rehabilitation on the lives of people with disabilities and their carers in low- and middle-income countries. Overall, randomised controlled trials suggested a beneficial effect of community-based rehabilitation interventions in the lives of people with physical disabilities (stroke and chronic obstructive pulmonary disease). Randomised controlled trials suggested a modest beneficial effect of community-based rehabilitation interventions for people with mental disabilities (schizophrenia, dementia, intellectual impairment), and for their carers (dementia). However, the methodological constraints of many of these studies limit the strength of results. In order to build stronger evidence, future studies will need to adopt better study designs, will need to focus on broader clients group, and to include economic evaluations.
Best wishes, Neil
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I am happy to read about child disability and successful CBR program [*see note below]
Thanks also to Rachel for your information about the CBR program also implemented in Indonesia, with positive result. However as a pediatrician, I am more concern with the prevention of disability in early childhood (0 -60 months), for that reason we have develop a home based pictorial developmental toolkit to monitor child development and to detect development delay (a proxy of childhood disability). Using this approach we could identify 30-40% children <5 years with development delay and about 5-9% at high risk for disability in rural and underserve areas in Indonesia. With proper management (habilitation) and a system of referral of developmental delay a decrease in number of childhood disability is possible. Our observation using intervention during the early years known as the golden period is more effective than rehabilitation at older age. I am wondering whether other child disability centers in LMIC have the same experience.
If you are interested in early prevention and intervention of childhood disability you contact me at my email address or Suryakanti foundation (www.suryakanti.or.id)
Suryakanti Foundation Bandung
Thank you for sharing this study supporting CBR for people with disabilities. For people working in the disabilities community, especially those developing CBR programs, Community-Based Rehabilitation in the Bolivian Amazon can be a helpful resource. Based on Theresa Glass’s experiences building a CBR program for children with disabilities, it provides the strategies and tools that helped make her program successful. Originally written in Spanish (https://goo.gl/f3vfHo), it is now also available in English (https://goo.gl/UW4bZj).
Hesperian’s book, Disabled Village Children, is also useful, particularly for making low-cost rehabilitation aids with limited resources. It includes directions for making crutches, wheelchairs, and therapy aids, and provides information on physical and developmental disabilities, addressing daily living skills, medications, and behavioral difficulties. Disabled Village Children is also available in English (https://goo.gl/kBo1Wp) and Spanish (https://goo.gl/T7TSem).
If you are interested in either of these resources, you can learn more about them on Hesperian’s website, or contact me with any questions. I hope they are useful for CBR programs and anyone working with people with disabilities.
Thanks for sharing the information about the systematic review on the impact of CBR on people with disabilities. This review looked at impact of CBR on persons with specific disabilities.
However, a majority of CBR programmes in low and middle income countries work with community workers and/or volunteers who receive limited training and focus on areas of generic functional disabilities such as vision, hearing and mobility, instead of a diagnosis of specific disabilities. Their focus is on improvement in daily living activities. This is reflected in their data collection as shown by our multi-country review in 2016 on the disability data collection systems in CBR programmes ( http://dcidj.org/article/view/476 ).
Therefore, it is not easy to find big studies that can show the impact of CBR on persons with specific disabilities. A systematic review looking at the impact on functional areas could turn up more evidence about the impact of CBR.
Dr Sunil Deepak
Schio/Italy & Gurgaon/India
HIFA profile: Sunil Deepak is Head, Scientific Department, AIFO, Bologna, Italy. www.aifo.it/english/ sunil.deepak AT aifo.it