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Purpose: Evaluation of Community-based Rehabilitation (CBR) is important for developing good practice and providing a foundation for evidence of efficacy of practice. Since not much is known about the extent to which monitoring and evaluation (M&E) are carried out within CBR programmes, this study aimed to enhance knowledge by focussing on current M&E activities, the need and capacity of programmes to conduct evaluations and the challenges experienced. 

Method: An online survey of 15 questions was developed, field-tested and sent out to 236 CBR managers in Africa, Asia and Latin America.  

Results: The majority (86%) of the respondents indicated that their programmes had been evaluated in the past.While this was mainly done by international donors (87%), only around half of the respondents reported programme participants as the main audience. Just over half of the programmes (54%) included people with disabilities, their families and community members in evaluation processes. Insufficient financial resources were considered the most important challenge to conduct evaluation, particularly in the African region and among smaller programmes. The complexity of CBR was also indicated as an important barrier to evaluation.

Conclusions and Recommendations:  Although evaluations have been widely implemented in CBR programmes, many of them are not locally owned, and people with disabilities and their families are often not included in evaluation processes. The issues of limited financial resources and CBR complexity reflect current discussions in other areas of mainstream development. It is therefore recommended that models for evaluation in CBR should learn from, and be embedded in, ongoing developments in mainstream evaluation in international developm

Purpose: The study aimed to (1) measure the Work Ability of employees with disability; (2) assess the factor structure of different potential models of Work Ability Index (WAI) for employees with disability; and (3) identify the best factor structure of Work Ability Index for employees with disability in the Malaysian cultural context.

Methods: Data was collected using the Work Ability Index (WAI) translated into Malay language. The study sample consisted of 275 employees with physical disability, from both public and private sectors across Malaysia. Descriptive statistics were calculated using IBM SPSS 20 to evaluate the score of each subscale and the cumulative index of Work Ability among employees with disability. Confirmatory factor analysis (CFA) was conducted using IBM SPSS AMOS 21 to assess the factor structure of WAI and evaluate the validity of the proposed models for employees with disability.

Results: The WAI scores were 29.5% poor, 35.3% moderate, 28.7% good and 6.5% excellent. In the validation process, a non-orthogonal two dimensional structure was identified. In this model of WAI, the subscales were attributed to two factors: (1) subjective Work Ability factor that consisted of subscales 1, 2 and 7; and (2) health-related Work Ability factor, comprised of subscales 3, 5, 4 and 6. These two factors were positively correlated, which indicates that employees with disability who exhibit positive subjective Work Ability tend to also report positive health- related Work Ability.

Conclusion: This study has provided the first Malay version of WAI and has paved the way for future studies on work ability among employees with disability. The WAI translation has been validated among employees with disability and has shown adequate psychometric properties, thus making it suitable to investigate the associations between aspects of work and their impact on the health of employees with disability. 

Purpose: A new Mobility Disability Scale (MDS) has been developed to assess the level of mobility disability among community-dwelling individuals. For it to be used effectively, a systematic evaluation of the psychometric properties isrequired. This study was conducted to determine the concurrent validity of the MDS among community-dwelling individuals, as compared to the Functional Independence Measure (FIM) and Functional Assessment Measure (FAM).

Method: Based on the survey of a semi-urban community, purposive sampling was used to select 52 individuals with mobility disability. All of them were evaluated using MDS and FIM FAM scales at the same time. Spearman’s Rankcorrelation coefficient was used to analyse the correlation of MDS scores with the FIM FAM scale scores.

Results: MDS scores had statistically significant negative correlation with FIM FAM total scale scores (r= -0.711) and the correlation was stronger when analysed with the mobility components of FIM FAM scales (r= -0.724).

Conclusion: The MDS possesses moderate concurrent validity with an existing functional scale. This indicates that it may be a suitable tool to quantify the level of mobility disability in persons with disability living in community.

Limitation: The psychosocial domain, though important, could not be compared with any gold standard measures due to unavailability of suitable scales.

Purpose: This study describes a cross-sectional assessment of infrastructure, human resources, and types of rehabilitation interventions provided in a sample of healthcare facilities in Ghana. The objectives were to (a) develop and pilot a questionnaire assessing rehabilitation capacity in LMICs, and (b) provide initial data regarding available rehabilitation care in rural Ghana.

Methods: Data was collected from a sample of rehabilitation workers at 9 facilities, comprised of 5 regional and 4 district hospitals, located in seven of the ten geographical regions of Ghana. Participants completed a modified version of the World Health Organisation's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care, adapted to reflect core indicators of rehabilitation infrastructure. Participating facilities were mailed questionnaires and agreed to subsequent site visits from the first author.

Results: There were several limitations associated with basic rehabilitation infrastructure. Consistent with previous research, significant human resources limitations were observed as hospital-based rehabilitation services were primarily rendered by 20 physiotherapists and 21 physiotherapy assistants across the 9 participating sites. No rehabilitation physicians were identified at any of the surveyed facilities. With regard to therapeutic interventions, management of musculoskeletal impairments was generally consistent with current evidence- based practices, whereas rehabilitative approaches for neurologic conditions were limited to physical rather than sensory-motor modalities.

Conclusions: For the first time there is study data which details the rehabilitation infrastructure, human resources, and interventions in Ghana. This study furthers the field through the adaptation and initial piloting of a rehabilitation assessment instrument that can be used in LMIC contexts.

Limitations: The questionnaire used for the study was modified from the questionnaire for assessing surgical care in resource poor countries, and has not yet been validated. Since the study was conducted in a convenience sample of rehabilitation/physiotherapy centres in Ghana, generalisability may be limited.

Purpose: This study aimed to examine the relationships between Sense of Coherence (SoC), Coping Strategies and Quality of Life (QoL) of parents of children with autism in Malaysia.

Method: Purposive sampling was used to recruit parents of children with autism from 3 Autism Centres run by NGOs. The parents were asked to complete a questionnaire.

Results: The results of the study show that SoC and cognitive reframing are important factors that are associated with QoL.

Conclusions: It is recommended that policy-makers and programmers at the Autism Centres conduct more training workshops for parents of children with Autism Spectrum Disorder (ASD), so that their overall QoL can be improved.

Limitations: Future studies could recruit more participants, especially parents at government centres.

Purpose: This study aimed to estimate the cost-effectiveness of a community- based rehabilitation (CBR) programme known as Inspire2Care (I2C), implemented in Nepal by Karuna Foundation Nepal. In the absence of any gold standard methodology to measure cost-effectiveness, the authors developed a new methodology to estimate the programme’s achievements and cost-effectiveness.

Methods: Financial records were reviewed to determine total expenditure during the period August 2011 - December 2013. Programme records which documented the physical, mental and social status of children and adults with a disability qualitatively before, during and after the intervention were used to determine a starting disability weight and improvement score, which was then converted into a change in disability weight. The disability weight and expected remaining lifespan of each person were used to estimate disability-adjusted life years (DALYs) averted by the intervention. The cost per DALY averted was estimated by dividing the total programme expenditure by the sum of DALYs averted over that same period.

Results: I2C cost 204,823 Euros to implement over the period August 2011- December 2013. In total, an estimated 1,065 DALYs were averted from the treatment and rehabilitation components. The cost per DALY averted was 192.34 Euros.

Conclusions and Implications: The methodology devised for the study was able to successfully estimate the cost-effectiveness of the I2C programme. Using WHO benchmarks, this programme can be considered highly cost-effective. Other organisations can assess the cost-effectiveness of their programmes by using the assessment improvement score and subsequent conversion to DALYs averted. However, while mental, physical and social gains have been captured, other benefits from I2C cannot be captured in the cost per DALY averted statistic. Further research is needed to develop methods for incorporating these harder-to- measure gains in cost-effectiveness studies with a single outcome measure like the DALY.

Teachers in rural Sri Lanka find it challenging to support students with Learning Difficulties (LD) in regular classrooms. As a result, students with LD often quit school early. Community- Based Rehabilitation (CBR) projects located in rural areas sometimes provide learning opportunities for students who are school dropouts.

Purpose: The research focussed on identifying an effective teaching approachthat Developmental Assistants (DAs) can employ when teaching students with LD.

Methods: An action research methodology with two action cycles was selected for this purpose. Each cycle consisted of four stages: analysing, reflecting, planning, and implementing and monitoring. Data collection involved semi- structured interviews and real-time observations. A combination of qualitative and quantitative methods was adopted for data analysis. Research participants included 11 students aged 8-14 years, their parents and two DAs.

Results: Outcomes suggest that students with LD actively engage in learning when an integrated approach that uses thematic units which reflect the students’ world, is in force. They also benefit when some elements of the behavioural approach to teaching-learning: explicit direct instruction, modelling, scheduled practice, reinforcement and feedback, are combined with certain components of the constructivist approach: independent work, group discussions and reflection.

Conclusions: The study demonstrates that students with LD can succeed when the teaching-learning process is modified to suit their needs. Hence, CBR project workers ought to be trained to plan and design lessons that meet the needs of students with LD. It further validates the role CBR projects can play in diminishing negative views on disability and in creating inclusive societies. 

Limitations: The study’s illuminative design was appropriate within a limited sample of students. However, this sample is not wholly representative of the multicultural and multi-religious student population with LD in hard-to-reach areas of Sri Lanka.

Purpose: This paper aims to understand the agency that caregivers who participated in a CBR empowerment component programme exercised, in order to promote the rights of their children with disabilities to a basic education.

Methods: An interdisciplinary theoretical framework and qualitative methodology were used to examine the agency and the opportunity structures within which the caregivers operate. Focus group discussions, case study interviews and secondary Programme data were analysed using manual thematic analysis.

Results: Thousands of children with disabilities in South Africa are effectively denied the right to a basic education as a result of discriminatory norms, stigmatising discourses and unjust power relations. Yet, a group of caregivers have successfully advocated for their children with disabilities in the township of Orange Farm, Gauteng. Their lobbying has contributed to the establishment, by the State, of a new school.

Conclusion and Implications: The findings suggest that human rights advocacy movements, as well as disability organisations, would do well to recognise and encourage the power and agency possessed by caregivers of children with disabilities. Catalysing civic action and providing opportunities for active citizenry and self-help seem to nurture increased efficacy and competence at navigating systems and accessing rights. While advocacy organisations may act as proxy agents, direct and collective agentic strategies should be nurtured. 

In implementing inclusive education, policy makers and the Department of Education should recognise the role that caregivers of children with disabilities can play, and the potential contribution that their motivation, resourcefulness, and disability-related knowledge can make.

Purpose: This research aims to identify a core set of clinical skills for working in a Community Based Rehabilitation (CBR) setting, and to discuss whether they are appropriate for task shifting to a new or an alternative cadre of rehabilitation workers.

Methods: The study focussed on work activities relating to the health component of the CBR Matrix. 40 health professionals working in CBR in Low and Middle Income Countries (LMIC) were surveyed to discover the clinical skills that were used most frequently during the past 3 months and to determine which of these skills were deemed most important in a CBR setting.

Results: A core set of clinical skills for health-related CBR work in LMIC were identified: advocacy and sensitisation; assessment, monitoring and reporting; behavioural and cognitive interventions; collaboration and referral; communication; continuing professional development; education; gait training; group work; home-based rehabilitation; manual therapy; neurofacilitation techniques; positioning; prescription of strengthening exercises; prescription of stretching programmes; provision of aids, assistive devices and technologies; psychosocial support; recreational therapy; self-care; sensory interventions; supervision; upper body rehabilitation; vocational rehabilitation and working with families.

Conclusions: It is possible to identify a core set of health-related CBR skills. These may be considered in the development of training programmes for new or alternative cadres of CBR workers, using a task-shifting model including appropriate support, supervision and referral mechanisms.

Implications: Further research is required to establish the generalisability of the skills sets identified here, both across contexts and different client groups and their needs. The identification of core sets of skills for other areas of the CBR Matrix - livelihood, social, empowerment and education – could similarly facilitate access to these domains for people with disabilities.