Date Presented 04/05/19
Community-Based Rehabilitation (CBR) was developed by the World Health Organization to fill the gap between increased disability and the lack of rehabilitation services in low- and middle-income countries. Research has shown that countries adopting the CBR model vary considerably in services offered and outcomes for program success. This abstract will reveal results from a systematic review that aimed to gather the evidence from all the published research on CBR programs since the year 2000.
Primary Author and Speaker: Rawan AlHeresh
Contributing Authors: Megan Griffin, Jenny Li
PURPOSE: Community-Based Rehabilitation (CBR) is a widely implemented multi-sectional strategy developed by the World Health Organization (WHO) to equalize opportunities for people with disabilities in health, education, and employment. CBR was developed to fill the gap between increased prevalence of disability globally and the lack of rehabilitation services in low and middle-income countries. Research has shown that countries adopting the CBR model vary considerably in services offered and outcomes for program success. The evidence body is vague and inconsistent in identifying areas of intervention in countries and organizations that chose to adopt the CBR model, therefore, the WHO- CBR Matrix was created. The objective of this study is to review the literature on CBR program interventions in low and middle-income countries (As classified by the World Bank) and map them to WHO-CBR Matrix (health, education, livelihood, social, and education) to gauge a better understanding of CBR services used including occupational therapy.
DESIGN: The study design is a systematic review.
METHODS: Three databases, PubMed, OVID and EBSCOhost, were searched using keywords associated with CBR in low-income and middle-income countries. Articles were screened based on their titles and then by abstracts by two independent reviewers to determine inclusion/exclusion. If a study passed the title and abstract screening, a full text was retrieved and analyzed independently by two reviewers. To be included, a paper need to be published in an English peer-reviewed journal between the years 2000 and 2007 and included an active component of CBR in a low, middle-income country as classified by the World Bank. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used in reporting the systematic review components. Data extracted from the articles include authors and year of publication, country, CBR site, study design, results, and intervention. The final step was to classify the identified CBR strategy according to the WHO-CBR Matrix into the recommended categories: health, education, livelihood, social, and education.
RESULTS: Nine hundred and fifty eight (958) article titles were screened and a total of 25 articles were included in the review. The majority of studies were conducted in the Asian continent followed by Africa. Most study designs were cross sectional. Articles were mapped according to the different types of study design and focus of intervention using the WHO-CBR matrix as the guiding framework. The health component was the leading ares of intervention with 12 studies, followed by the social component with 6 studies reporting it. The remainder of the articles had minimal presence in the livelihood, empowerment, and education components with 3, 3, and 1 study respectively.
CONCLUSION: This is the first systematic review to explore CBR strategies and components using the WHO-CBR strategy matrix recommended by the WHO. We found that most of the interventions focused on health. There was very limited research and intervention in education which could be an ideal platform for occupational therapy to increase activity and participation for people with disabilities especially in schools in low and middle income countries globally.
IMPACT STATEMENT: With only 0.7 occupational therapists available per million population in low and middle-income countries, this systematic review highlights the need for establishing rehabilitation services including occupational therapists in these countries especially in the education sector.
RELATES TO RESEARCH PRIORITIES: This study builds on the WHO and the WFOT recommendations for using CBR globally and this is the first research study to include the WHO-CBR matrix.
References
World Health Organization. (2017). Community-based rehabilitation (CBR): What WHO is doing. Retrieved from http://www.who.int/disabilities/cbr/activities/en
Mason, C., Weber, J., Atasoy, S., Sabariego, C., & Cieza, A. (2017). Development of indicators for monitoring community-based rehabilitation. PLOS ONE, 12(6), e0178418. https://doi.org/10.1371/journal.pone.0178418
